Use of Jury Instruction on Foreseeability in Medical Negligence Case

The Supreme Court of Ohio recently discussed foreseeability in the context of medical negligence. The court held that foreseeability of the risk of harm may be considered when determining a medical professional’s duties, but it need not always be considered.

Med Neg trialA five-year-old boy presented at a hospital’s emergency room with an elevated pulse and rate of respiration, a tender abdomen with pressure, pale skin, normal temperature, and normal blood pressure. After being treated for shock in the ER and the pediatric intensive-care unit (PICU), the boy died.

The boy’s parents brought a medical negligence action against the hospital, alleging that the boy’s death was caused by the combined and individual negligence of multiple hospital employees. After the close of evidence, the hospital requested an instruction on the foreseeability of harm using language from the general negligence provisions of the Ohio Jury Instructions. The trial court ultimately instructed the jury on the elements of negligence as they applied to the hospital and its employees and gave an instruction on foreseeability that asked the jury to determine whether the hospital employees should have foreseen that the boy’s death was a likely result of their actions or failure to act.

The jury returned a verdict in favor of the hospital. The trial court entered judgment on the jury verdict and denied the parents’ motion for a new trial. The Court of Appeals reversed and remanded, holding that the trial court’s instruction on the foreseeability of the risk of harm during medical treatment constituted an incorrect statement of law that required reversal.

The Supreme Court of Ohio reversed the appellate court and remanded. The court held that the foreseeability instruction was not warranted. The jury instructions, however, regarding the applicable standard of care were not misleading as a whole and, thus, were not prejudicial.

The court explained that foreseeability is generally relevant to a determination of whether a physician has exercised reasonable care in understanding or determining the existence of a risk of harm associated with a particular course of treatment. But, when the parties do not dispute that a physician conducted a risk-benefit analysis prior to treating a patient and do not dispute that the physician understood that the chosen course of treatment carried some risk of harm, a jury instruction regarding the foreseeability of harm need not be given. However, the use of this instruction is not patently prejudicial, and a judgment is not subject to reversal absent a showing of material prejudice.

The concept of foreseeability is an important part of all negligence claims, because the existence of a duty depends on the foreseeability of the injury.

The court held the foreseeability instruction was not warranted reasoning that, in the context of an established physician-patient relationship, there was no need to independently determine whether the patient fell within the class of people who could foreseeably be injured, because the existence of the physician’s duty to that patient was already clear. Thus, foreseeability was irrelevant to a determination of a physician’s duty.

The court’s holding was closely tied to the facts of the case. The court reasoned that the treating physicians were not accused of failing to foresee that the negative effects of the progression of shock and the strain on a patient’s cardiovascular system were risks of delaying the intubation of a patient in shock. They admitted to having knowledge of these risks and weighing them against the risks and benefits of performing other precautionary measures prior to intubation. Thus, the parties did not dispute that the treating physicians foresaw that there was a risk of harm associated with their choice of emergency treatment. Instead, they debated whether the physicians reasonably appreciated the magnitude of the risk and properly weighed it in their risk-benefit analyses. Accordingly, the question remaining was whether the physicians’ chosen course of treatment was reasonable in light of the risks. There was no question for the jury in this case regarding the foreseeability of the risk of harm because the medical professionals were aware that their chosen chronology of treatment of the boy’s shock carried with it some risk of harm. Thus, the instruction regarding the foreseeability of harm was not necessary in light of the facts and arguments presented in this case.

By Sarah Kelman, JD, and the experts and editors at Medical Law Perspectives.

For more details, see the Scalpel Weekly News, February 9, 2015.

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See also Medical Law Perspectives, December 2012 Report: When Urgency Leads to Errors: Liability for Emergency Care

See also Medical Law Perspectives, March 2014 Report: Blood Draws, Testing, Transfusions: Venipuncture Injury, Inaccurate Results, Tainted Blood – The Liability Risks

See also Medical Law Perspectives, November 2013 Report: Diagnosis and Treatment of Heart Attacks: Liability Issues

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The content of this blog is provided for informational purposes only, and does not constitute legal advice.
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