Cox v. St. Josephs Hospital, 71 So. 3d 795

Cox suffered an ischemic stroke at age 69, resulting in permanent paralysis and aphasia.
Plaintiffs obtained a substantial jury verdict for medical malpractice against St. Joseph’s Hospital, the ER doctor, and the doctor’s practice.
The central causation question was whether administering tPA would more likely than not have mitigated Cox’s damages.
The ER doctor failed to obtain or consider the stroke onset time, which is critical to tPA eligibility.
Plaintiffs’ causation evidence centered on Dr. Futrell, a vascular neurology expert who opined Cox would have had a good recovery with tPA.
The Second District reversed, finding Futrell’s testimony speculative and not meeting causation standards; this Court granted review.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Did the district court impermissibly reweigh causation evidence?	Futrell’s testimony showed a greater than de minimis chance of benefit.	The district court properly evaluated conflicting medical literature and cross-examination.	Yes, it impermissibly reweighed the evidence.
Does causation require more than speculation when expert opinion references medical studies?	Expert connected Cox’s case to tPA benefit via established data and records.	Cross-examination undermined credibility and the NINDS study contradicted the opinion.	No, expert testimony grounded in records and literature is permissible; appellate reweighing is improper.

Wale v. Barnes, 278 So.2d 601 (Fla.1973) (prima facie causation via expert testimony in conflicting-evidence cases)
Gooding v. University Hospital Building, Inc., 445 So.2d 1015 (Fla.1984) (directed verdict where survival not more likely than not even with immediate care)
St. Joseph’s Hosp. v. Cox, 14 So.3d 1124 (Fla. 2d DCA 2009) (district court impermissibly reweighed expert causation testimony)