260 So. 3d 977
Fla.2018Background
- Patient Maria Espinosa presented with a skull-invading tumor and abnormal pre-op tests (blurry EKG flagged as abnormal; urinalysis with proteinuria on second page).
- Neurosurgeon recommended immediate debulking surgery; surgery scheduled at Hialeah Hospital.
- Dr. Arturo Lorenzo (anesthesiologist) performed a brief pre-anesthesia evaluation in place of the assigned anesthesiologist, reviewed some but not all chart data, and did not report abnormalities to the surgeons.
- Dr. Velasquez subsequently completed the pre-op evaluation, reviewed the tests (including the proteinuria), and cleared the patient for surgery as well.
- During surgery Espinosa suffered massive bleeding, went into cardiac arrest, and died; tumor later identified as multiple myeloma.
- Ruiz sued multiple physicians, including Dr. Lorenzo; trial court granted directed verdict for Dr. Lorenzo on proximate-cause grounds; Third DCA affirmed; Florida Supreme Court quashed and remanded.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether directed verdict was proper on proximate cause | Ruiz: Lorenzo's failure to read/report abnormalities substantially contributed to death because surgery would have been canceled if multiple myeloma had been recognized | Lorenzo: Any negligence merely furnished the occasion for independent acts of others; he was not the primary cause of death | Reversed: Proximate cause does not require being the primary cause; jury question may exist if Lorenzo's omission substantially contributed as part of a natural sequence |
| Standard for proximate causation in medical malpractice | Ruiz: "more likely than not" and foreseeability; omission that set in motion events can be proximate cause | Lorenzo: Must be primary cause to be liable; trial court analogized him to a passive actor | Court: Reaffirms "more likely than not" standard and that substantial contribution, not primacy, controls proximate cause |
| Preclusion by intervening acts of other treating physicians | Ruiz: Subsequent treating physicians' actions do not automatically insulate earlier negligent providers | Lorenzo: Subsequent providers were the efficient intervening cause | Court: Cites precedent rejecting insulation when later acts were a direct, natural sequel to initial wrong; leaves factual decision to jury |
| Whether record lacked competent substantial evidence to submit causation to jury | Lorenzo: Record shows exsanguination was primary cause and no evidence tied test abnormalities to death | Ruiz: Evidence that reporting abnormalities would have canceled surgery and avoided death creates a causal inference | Court: Third DCA erred to conclude no evidence as a matter of law; remands for factual determination by jury/district court |
Key Cases Cited
- Friedrich v. Fetterman & Assocs., P.A., 137 So.3d 362 (court may affirm directed verdict only when no view of evidence supports nonmoving party)
- Owens v. Publix Supermkts., Inc., 802 So.2d 315 (directed verdict standards and appellate reweighing of evidence)
- Cox v. St. Joseph's Hosp., 71 So.3d 795 ("more likely than not" causation standard; appellate courts must not reweigh jury evidence)
- Saunders v. Dickens, 151 So.3d 434 (subsequent treating physician testimony cannot automatically insulate earlier physician from liability)
- McCain v. Fla. Power Corp., 593 So.2d 500 (harm is proximate when prudent foresight would expect similar harm from the act; substantial factor test)
- Gooding v. Univ. Hosp. Bldg., 445 So.2d 1015 ("more likely than not" standard for proximate cause in medical malpractice)
- Sardell v. Malanio, 202 So.2d 746 (initial actor can be proximate cause where later act was a direct, natural sequel)