Analyzing Nursing

Malpractice Court Cases,

Lexis-Nexis On-Line,
Public Policy Making Process
N353 Dr. E. Watson
2009-2010

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 Analyzing Legal Cases

• Darling v. Charleston Community Hospital, 211 N.E.2d 53(Illinois, 1965)

• Plaintiff—party bringing lawsuit--Darling

• Defendant—party against whom the case is filed—Charleston Community Hospital

• Set of law reporters which publish opinions and decisions of state/federal courts

• State and dates are last **a state listed in the citation indicates the highest court
within the state heard the case
• This case was decided by the Illinois Supreme Court in 1965 and can be located in
volume 211 of the Northeast Reporter, Second Series, beginning on page 53

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 Elements of Malpractice
• Lexis/Nexis/Westlaw Assignment
• Review Opinion Section of Selected Case
• Chin v. St. Barnabas Medical Center
• Article Review:
• Duty
• Breach of Duty
• Foreseeability
• Causation (proximate cause)
• Injury
• Damages

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 Cause of Action Elements
1. Duty—nurse patient relationship and employment.
Basis of duty-owed concept (reliance relationship).
One person depending on another for quality and
competent care
Duty of care: duty to patient must be shown, scope of duty
must be proven

2. Breach of duty owed the patient—involves a deviation in

the standard of care by either—doing something that
should not have been done or nothing was done when
it should have been done (e.g. medication omissions)

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3. Foreseeability—certain events can be reasonably
expected to cause specific results—CHALLENGE: to
show that one could reasonable foresee a certain
result based on the facts as they existed at the time
of the occurrence rather than what could be said on
retrospective thinking and results

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4. Causation—requires injury to be directly caused by breach of
duty owed to patient. Two types:
1. Proximate Cause—builds on foreseeability by 1) attempting
to determine how far liability of defendant extends for
consequences following a negligent act; 2) looks at
standard of care; 3) fairly easy to prove as long as result is
directly related –look at intervening variable (s)

2. Cause-In-Fact: breach of duty caused harm/injury—med error

Tests to determine Cause-In-Fact
a. But-for-Test—answers the question if the act or omission is a
direct cause of the injury sustained

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b. Substantial Factor test—used when several causes occur to
bring about a given injury. Test is not to determine certainty, but
to develop a causal link between actions and injury. Test asks if
the defendant’s act or omission was a substantial factor in
causing the ultimate harm/injury—if yes—cause in fact.

C. Alternative Causes—more than one person is accused of

negligence—plaintiff must prove that the injury was caused by
one of the defendants—burden shifts to defendants to show
who actually caused the harm—if none can prove innocence—
all may be liable—not often used by courts

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5. Injury/Harm—3 types
a. Physical—pain and suffering
b. Financial
c. Emotional—usually not allowed as sole basis for lawsuit,
exceptions exist

HCP’s must take steps to assess a particular patient’s susceptibility

to foreseeable adverse reactions and take steps to reduce
them—as in previous shown lawsuits

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6. Damages
a.General damages: pain and suffering-past, present, future and
any permanent disability or disfigurement
b. Special damages: losses and expenses—past, present-future
(life careplanner)
c.Emotional damages: if there is physical damage—also
exceptions
d.Punitive damages: malicious misconduct. Not usually covered by
professional insurances. Intended to punish individual.
e. Compensatory damages: general and special damages
f. Total Damages Award: based on % of defendants actions in
causing harm

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 Res Ipsa Loquitor
‘the thing speaks for itself’
• A. rules of evidence—negligence without all 6 elements
--no expert testimony is needed
--plaintiff cannot prove how or who caused the injury
--injury is the type that in the absence of negligence, injury would not
have occurred

Ybarra—landmark case
--usually occurs in OR—unconscious patient, infant
--e.g. sponge or instrument left in patient

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b. Causes of Action Elements:
1. Injury does not occur without someone’s negligence

2. Accident must be caused by an agency within exclusive

control of defendant

3. Accident must not have been due to any voluntary

action/contribution on part of the plaintiff
Sides v. St. Anthony’s Medical Center

Supreme Court of Missouri Opinion 8/05/08

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 California Legislative Process
• Bills are considered and laws enacted
• 2 Houses
• 40 Senators
• 80 Assembly Members
• Discuss:
Overview of Legislative Process
Guide to Legislative Process
Researching California Public Policy: Tracing a
Legislative and Regulatory History

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