What is Proximate Cause in a Florida Medical Malpractice Case?

1174405_baseball_-_game_time_action.jpgMedical malpractice cases in Florida require a plaintiff to prove (1) the standard of care owed by the health care professional, (2) the health care professional’s breach of that standard, and (3) that the breach “proximately caused” the damages claimed. “Proximate cause” in Florida means that the negligence more likely than not caused the injury. It isn’t sufficient to show that what was done or not done by a health care professional probably affected the outcome. Usually an expert doctor must testify on this point.

In a recent case, a seventeen-year-old boy diagnosed with aortic stenosis collapsed during a preseason baseball workout. Aortic stenosis is a heart condition in which the aortic valve ‘narrows’ and the heart has a reduced ability to pump blood, which puts the person suffering from the condition at an increased risk for a heart attack.

Prior to his death, the boy was cared for by a pediatric cardiologist who saw him every year to administer stress tests and echocardiograms. The doctor agreed that the boy could play baseball but not contact sports. In 2001, the doctor told the boy he would need a stress test before starting the 2002 baseball season. The stress test was not performed before the new season.


However, after the test and an additional test by his colleague, the doctor signed a sports medical authorization that stated the boy could play all sports except football. He discussed the risks and benefits of the boy’s sports participation with the boy and his parents and asked the boy to return for a cardiology follow-up in six months.

However, three years passed and the boy didn’t see the cardiologist. He was seen by primary care physicians, including Dr. Shartz, a pediatrician. The pediatrician asked when the boy had last seen a cardiologist. The pediatrician and the parents had different views of the responses. The pediatrician believed that the boy had seen his cardiologist within the last year and he was current on his evaluations. The mother testified it had been at least a year since he had seen a cardiologist. The pediatrician, believing the boy was current, authorized him to play sports.

During a phone call with the cardiologist, the pediatrician learned the boy had not actually been to a cardiologist in years. The cardiologist also advised that the boy not play sports. The pediatrician later testified he tried to revoke the authorization, but the parents claimed they never got the messages or letters.

The parents admitted at trial that they knew the boy would need an echocardiogram and stress test in order to participate in varsity baseball. They didn’t take the boy and he died as a result of his participation in sports.

The parents sued for medical malpractice. At trial, they retained a family medicine physician to testify on the standard of care. She criticized the pediatrician for signing the release without first speaking to the boy’s cardiologist. She testified this fell below the standard of care and that it substantially contributed to the boy’s death because it made the parents think he was cleared to play.

The mother also presented testimony from the cardiologist’s colleague who had performed a test on the boy years previously. She testified that if the boy had returned for testing, she would have ordered more invasive testing if the echocardiogram showed the aortic stenosis was progressing. The autopsy showed that the cause of the boy’s death of congenital aortic valve stenosis.

At the close of evidence at trial, the pediatrician and another defendant moved for a directed verdict. They argued that the parents failed to show that their actions and inactions proximately caused the boy’s death. The jury decided in favor of the boy’s mother, as representative of his estate. They found liability on the part of the school board, the doctor, and the parents.

The pediatrician appealed, arguing that the expert opinions did not close the loop to show that had he spoken with the parents or confirmed with them that he revoked medical authorization, the boy would not have participated in baseball conditioning or suffered a cardiac event. The expert was not a cardiologist and couldn’t give an opinion as to whether the pediatrician’s action contributed to the death.

The appellate court reasoned that an expert’s opinion needed to be based on foundational facts. In this case, the parents had not testified that they would have taken the boy to a cardiologist or that the cardiologist would have prevented the boy from participating in baseball conditioning. The only cardiologist called to testify had not seen the boy in over two years and so could not offer an opinion on his condition.

The appellate court concluded that the boy “possibly” living if the pediatrician taken different actions was not the standard. Too many inferences needed to be made that were not supported by the facts. The jury’s verdict was overturned.

If you or a loved one has been hurt because of a health care provider’s negligence, call the experienced South Florida medical malpractice attorneys at Friedman, Rodman & Frank toll-free for a free consultation at (877) 448-8585.

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