Articles Tagged with medical malpractice

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shutterstock_668481628-300x200In a brand-new opinion, Ruiz v. Tenet Hialeah Healthsystem, Inc., et al., the Supreme Court of Florida reinforced that the concept of causation in medical malpractice is broad and should be left to a jury. The fact pattern in Ruiz involved a patient who was misdiagnosed with a tumor instead of multiple myeloma. Without ordering a biopsy to confirm the diagnosis, the treating neurosurgeon recommended a surgery to remove the “tumor”. During the surgery, the patient, Ms. Espinosa, went into cardiac arrest due to undiagnosed cardiac risk factors and passed away.

Ms. Espinosa’s estate brought a wrongful death medical malpractice case against a host of doctors and the hospital. One of the defendants was an anesthesiologist, Dr. Lorenzo, who had failed to recognize abnormal test results during the pre-operative clearance. The estate contended that had the defendant anesthesiologist pronounced these abnormalities, the surgery would have been cancelled and Ms. Espinosa would not have died.

The defendant doctor sought to have the case dismissed based on a failure to prove causation, e.g., that he was the legal cause of the patient’s death. Causation is a legal concept that bridges the gap between a defendant’s wrongdoing (negligence) and the damages sought by the plaintiff. In every personal injury and medical malpractice case, the plaintiff must prove that the defendant’s negligence was the legal and proximate cause of the injuries and damages that she is claiming.

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Florida has a very complex medical malpractice statutory scheme that an injured victim must follow in order to bring a case. Codified under chapter 766, the medical malpractice statutes require great skill to navigate. Amongst a host of other requirements, an injury victim must send relevant data to an expert medical professional in the same or similar specialty as the health care provider who you are going to bring suit against. That expert must then issue an affidavit verifying the negligence. The expert affidavit, along with several other documents, must then be served on the defendant doctor as part of a Notice of Intent to Initiate Medical Malpractice Litigation. All of the above must be accomplished within the two-year Statute of Limitations that Florida law affords victims of medical malpractice.

The recent case of Bay County Board of Commissioners v. Seeley provides us with a nice look at just how complex medical malpractice litigation can be. In Seeley, the plaintiff was injured when she fell off a stretcher while being wheeled by paramedics from her home to the awaiting ambulance. At first, she filed a lawsuit without complying with the medical malpractice pre-suit screening process because she did not believe her case was for medical negligence. That lawsuit was dismissed as the trial court determined her allegations were in fact medical malpractice in nature and thus she had to comply with the requirements of chapter 766.

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In Woodson v. Go, Florida’ Fifth District Court of Appeal (“Fifth DCA”) held that even in complex medical malpractice cases, the trial court has broad discretion to place limitations on expert witnesses. The holding represents a self-proclaimed rescission from Lake v. Clark, a 1988 Fifth DCA decision that overturned a trial court’s exclusion of a doctor’s expert witness testimony on standard of care.

The Woodson case involved a Plaintiff who claimed medical malpractice for negligent placement of a cardiac cauterization and failure to timely detect the resulting occlusion. To further his case, the plaintiff sought to call two interventional cardiologists as expert witnesses. The trial court allowed this, but limited one expert to liability only and the other only to causation. The Defendants all denied liability and maintained that they properly met the standard of care. At trial, the Defendants were victorious on liability which prompted the Plaintiff to appeal the final judgment based on the limitation of expert witnesses.

In upholding the verdict for the Defendants, the Fifth DCA held, “…we see no reason to permit litigants in medical malpractice cases to have an almost unfettered right to present cumulative expert witness testimony.” Applying an abuse of discretion standard, the appellate court noted black-letter Florida law that gives trial courts broad discretion in placing limitations on expert witnesses. See Lion Plumbing Supply, Inc. v. Suarez, 844 So. 2d 768, 770 (Fla. 3d DCA 2003); Elder v. Farulla, 768 So. 2d 1155 (Fla. 2d DCA 2000). The court also referenced Fla. Stat 90.612(1)(b), Fla. Stat. 90.403 and Fla. R. Civ. P. 1.200(b)(4), all of which give the trial court the duty and power to limit cumulative testimony, including that of experts, for the purposes of an expedient trial.

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In a landmark decision, Florida’s Fourth District Court of Appeal (“Fourth DCA”) in North Broward Hospital District v. Kalitan held that caps on non-economic damages in personal injury medical malpractice cases violate the Equal Protection Clause of the Florida Constitution.

The Plaintiff,  Susan Kalitan, suffered serious injury due to medical negligence when she went in for a carpal tunnel surgery that required anesthesia. The Defendant/anesthesiologist punctured a hole in her esophagus while performing intubation. When Ms. Kalitan awoke after surgery, she complained of excruciating pain in her chest and back but the anesthesiologist failed to detect the problem. She was released from the hospital, but the next day Ms. Kalitan’s neighbor found her at home unresponsive. She was rushed back to the hospital for life-saving surgery. Ms. Kalitan spent several weeks in a drug-induced coma before having additional surgeries and intensive therapy to begin eating again and regain mobility. She presently suffers from pain in the upper half of her body and serious mental disorders as a result of this traumatic incident and loss of independence due to physical limitations.

At trial, the jury awarded Ms. Kalitan $4 million in non-economic damages, but that figure was reduced by the trial court post-verdict to $2 million under the non-economic damages caps found in Fla. Stat. 766.118. The trial court denied the Plaintiff’s arguments that the caps were unconstitutional violations of the Equal Protection Clause, her right to access the courts and her right to trial by jury.

Ms. Kalitan appealed the reduction of her jury-awarded damages to the Fourth DCA where she was victorious. Judge Forst delivered the opinion for the appellate court, wherein he carefully followed the Florida Supreme Court’s rationale in Estate of McCall v. United States, 134 So. 3d 894 (Fla. 2014). In Estate of McCall, the Florida Supreme Court ruled that caps on non-economic damages in wrongful death cases violated Florida’s Equal Protection Clause as, “the greater the number of survivors and the more devastating their losses are, the less likely they are to be fully compensated for those loses”, particularly in comparison to cases where there was only one survivor.

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