Examkin

Question

Difficulty: HardMedical Malpractice and Legal Issues

A 68-year-old man presents to an outpatient clinic with a 2-day history of right calf pain and swelling. A duplex ultrasound confirms a deep vein thrombosis. The evaluating physician prescribes a direct oral anticoagulant. However, the physician fails to review the patient's electronic medical record, which clearly documents a hospitalization two weeks prior for a severe gastrointestinal hemorrhage—an absolute contraindication to anticoagulation. The patient takes the prescription to a local pharmacy. While walking up the pharmacy steps before filling the prescription, he trips, falls, and strikes his head. He sustains a severe traumatic subdural hematoma requiring an emergency craniotomy and a prolonged intensive care unit stay. He never fills or ingests the anticoagulant. The patient's family subsequently files a medical malpractice lawsuit against the clinic physician, citing the negligent prescription of the contraindicated medication.

To establish a successful medical malpractice claim based on negligence, four specific elements must be proven. Based on this clinical encounter, which of the following required elements of negligence are definitively established? (Select all that apply)

  1. A pre-existing legal duty of care owed by the physician to the patientAnswer
  2. A breach of the accepted standard of care by the physicianAnswer
  3. C
    Proximate causation linking the physician's medical error to the patient's injury
  4. D
    Actual compensable damages sustained as a direct result of the physician's medical error
  5. E
    Applicability of the legal doctrine of res ipsa loquitur

Answer

The definitively established elements are a pre-existing legal duty of care and a breach of the accepted standard of care.
A medical malpractice claim based on negligence requires the plaintiff to prove four elements: Duty, Breach, Causation, and Damages. In this scenario, a physician-patient relationship was established during the clinic visit, creating a legal duty of care. The physician also breached the standard of care by failing to review the medical record and prescribing a contraindicated anticoagulant. Therefore, Duty and Breach are definitively established. However, because the patient never ingested the medication and his injuries were caused by an independent fall, Causation and Damages stemming from the medical error are absent.

Step-by-Step Solution

1
Identify the four essential elements of a medical malpractice claim based on negligence.
The four elements are Duty, Breach, Causation, and Damages.
All four elements must be proven by a preponderance of the evidence for a plaintiff to prevail in a malpractice lawsuit.
2
Analyze the scenario for the presence of a Duty of Care.
The physician evaluated the patient in the clinic, establishing a formal physician-patient relationship and a legal duty of care.
A duty of care arises when a physician undertakes the treatment of a patient.
3
Analyze the scenario for a Breach of Duty.
The physician prescribed a contraindicated medication by failing to check the patient's recent medical history.
This action deviated from standard medical practice, establishing a breach of the standard of care.
4
Analyze the scenario for Causation and Damages resulting from the breach.
The patient's injuries (subdural hematoma) and damages (ICU stay, surgery) were caused by a mechanical fall, not by the erroneously prescribed anticoagulant, which was never taken.
Without causation linking the specific error to the specific damages, the malpractice claim is incomplete.

Key Concept

To establish medical negligence, a plaintiff must prove four elements: Duty, Breach, Causation, and Damages. A physician may commit a severe medical error (breach of duty), but if that error does not proximately cause actual damages, a malpractice claim will fail.
Rate this question

Topics

Medical Malpractice and Legal Issues

More questions from this topic