Ruby Saunders, etc. v. Willis Dickens, M.D., 151 So. 3d 434

Saunders sued Dr. Dickens and others for failure to diagnose and resulting injuries; Fabre defendant issue and causation were at trial.
Trial evidence included neurologist and orthopedic testimony; expert opinions debated whether cervical compression or lumbar pathology caused Saunders’ symptoms.
Dickens argued causation defense based on Pasarin’s testimony that he would not have altered treatment even if a cervical MRI had been ordered.
Fourth DCA held closing statements shifting burden improperly were error and that a plaintiff need only prove that adequate care more likely than not would have prevented injury.
Court quashed the Ewing-based reasoning, disapproved Ewing, and approved Goolsby and Muñoz, adopting the causation standard that does not rely on subsequent treating physicians’ actions to insulate a defendant.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Standard of causation in medical negligence	Saunders argues causation is shown if defendant's negligent care more likely than not caused injury.	Dickens argues subsequent care would not have altered outcome, so causation fails under Ewing.	More likely than not causation required; Ewing disapproved.
Effect of subsequent treating physician testimony	Subsequent physician testimony cannot absolve defendant; jury should decide causation.	That testimony can show no change in outcome, supporting no causation.	Testimony cannot insulate a physician from liability; irrelevant to ultimate causation if standard of care was breached.
Conflict with Muñoz and Goolsby	Fourth DCA conflict with Muñoz/Goolsby warrants Supreme Court review.	No express and direct conflict existed as the case is distinguishable on facts.	Court adopts Muñoz and Goolsby; conflict exists and jurisdiction valid.

Ewing v. Sellinger, 758 So.2d 1196 (Fla. 4th DCA 2000) (presumed causation not established by later treating physician testimony)
Goolsby v. Qazi, 847 So.2d 1001 (Fla. 5th DCA 2003) (rejects Ewing-like rationale; allows jury to decide causation)
Muñoz v. South Miami Hospital, Inc., 764 So.2d 854 (Fla. 3d DCA 2000) (subsequent treating physician's hypothetical actions not conclusive)
Gooding v. University Hosp. Bldg., Inc., 445 So.2d 1015 (Fla. 1984) (negligence standard; burden on plaintiff to prove lack of reasonable care)
Pate v. Threlkel, 661 So.2d 278 (Fla. 1995) (defines standard of professional care in medical malpractice)
Fabre v. Marin, 623 So.2d 1182 (Fla. 1993) (apportions fault among responsible parties; used in Fabre context)