A large mass developed in the back of a patient’s head. The patient’s primary care physician diagnosed the mass as a tumor and referred the patient to a neurosurgeon.
The neurosurgeon believed the tumor to be an osteosarcoma, a malignant type of bone cancer that begins in the cells that form bones. The neurosurgeon did not order a biopsy of the tumor. Imaging studies of the tumor showed it had invaded the patient’s skull and could soon begin to press upon the brain. The neurosurgeon recommended immediate surgery to remove some of the tumor’s mass, a process known as debulking the tumor, and render the mass more susceptible to other forms of treatment, such as radiation or chemotherapy.
The patient underwent a number of tests to ensure the patient was medically fit to undergo surgery. The patient’s preoperative electrocardiogram (EKG) was abnormal, indicating the patient’s heart may have been enlarged and that the patient may have suffered two myocardial infarctions. The patient’s preoperative urinalysis was abnormal, indicating the abnormal presence of protein in the patient’s urine, a condition known as proteinuria. The patient’s primary care physician cleared the patient for surgery.
On the day of the procedure, an anesthesiologist performed the patient’s preanesthesia evaluation. The anesthesiologist asked the patient questions about medical history and present condition. The anesthesiologist reviewed some of the test results in the patient’s chart. The anesthesiologist believed the abnormal EKG results were caused by a malfunction of the EKG machine and not by any problem with the patient’s heart. The anesthesiologist reviewed the first page of the patient’s urinalysis results, but not the second page where the abnormal proteinuria reading was displayed.
After this anesthesiologist had completed about half of the preanesthesia evaluation, a second anesthesiologist took over. During this transition, the first anesthesiologist told the second anesthesiologist that there was nothing, no major medical problems whatsoever, although the second anesthesiologist may want to look at the EKG. The first anesthesiologist did not inform the patient’s surgeons about the abnormal EKG or urinalysis results. The first anesthesiologist signed the preanesthesia form.
The second anesthesiologist began the preanesthesia evaluation from the beginning. The second anesthesiologist reviewed the EKG and the urinalysis results, including the proteinuria reading. The second anesthesiologist did not inform the patient’s surgeons about the abnormal EKG or urinalysis results. The second anesthesiologist signed the preanesthesia form and cleared the patient for surgery.
During the surgery, the patient lost a large amount of blood and suffered a precipitous drop in blood pressure, which the physicians were unable to reverse. The patient went into cardiac arrest and could not be resuscitated. An autopsy and pathology test revealed that the tumor was caused by a type of plasma cell cancer known as multiple myeloma.
The patient’s estate brought a medical malpractice action against the first anesthesiologist and other health care providers involved in the patient’s treatment. The complaint alleged that the patient’s death was caused by the failure to correctly diagnose the patient’s condition as multiple myeloma, which should only be treated through radiation or chemotherapy because surgery is inappropriate. The complaint argued that the surgery would have been canceled and the patient would have survived had the patient been correctly diagnosed at any point. Specifically, the complaint alleged that the first anesthesiologist breached the standard of care by not reviewing all the available data in the patient’s chart, not ordering a second EKG to reconcile the abnormal results of the first EKG, and not reporting the abnormal lab results to the patient’s surgeons. The complaint contended that, had the first anesthesiologist adhered to the standard of care, either the first anesthesiologist or the surgeons would have realized the patient was suffering from multiple myeloma and the surgery would have been canceled.
During trial, the first anesthesiologist testified that the proteinuria reading would not have affected the first anesthesiologist’s determination of whether it was safe for the patient undergo anesthesia.
The Circuit Court, Miami–Dade County, granted the anesthesiologist’s motion for directed verdict. The trial court held that, even assuming the first anesthesiologist was negligent in caring for the patient, the first anesthesiologist did nothing more than place the patient in a position to be injured by the independent actions of the surgeons.
The Third District Court of Appeal of Florida affirmed. The appellate court concluded that no competent, substantial evidence in the record would allow a reasonable factfinder to conclude that the first anesthesiologist was the primary cause of the patient’s death.
The Supreme Court of Florida reversed. The court held that it was a jury question whether the anesthesiologist’s failure to read and report the patient’s abnormal preoperative lab test results was the proximate cause of the patient’s death, rather than a question suitable for summary disposition.
The issue of whether the anesthesiologist’s failure to read and report the patient’s abnormal preoperative lab test results was the proximate cause of the patient’s death was for the jury. The court clarified that the issue was whether there was competent, substantial evidence in the record which would permit a reasonable factfinder to conclude that the first anesthesiologist, more likely than not, proximately caused the patient’s death. The court explained that the law does not require a physician’s act to be the exclusive or even the primary cause of injury in order for that act to be the proximate cause of the injury. The court found that the first anesthesiologist’s conduct was not the primary cause of the patient’s death, but the first anesthesiologist may be liable if the failure to read and report the abnormal test results substantially contributed to causing the patient’s death. The court explained that the first anesthesiologist could not prevent the estate from establishing proximate cause merely by showing the failure to read and report the abnormal test results was not the primary cause of the patient’s death. Instead, the first anesthesiologist’s acts or omissions must not have substantially contributed to the patient’s death as part of a natural and continuous sequence of events which brought about that result. The court concluded that the appellate court erred by equating the proximate cause of an injury with the primary cause of an injury.
The Supreme Court of Florida quashed the decision of the appellate court affirming the trial court’s grant of a directed verdict in favor of the anesthesiologist and remanded.
See: Ruiz v. Tenet Hialeah Healthsystem, Inc., 2018 WL 6696028 (Fla., December 20, 2018) (not designated for publication).
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