An Introduction to Medical Malpractice in the United States

Medical malpractice law in the United States is rooted in the foundations of English common law and has evolved through a series of rulings in state courts. The landscape of medical malpractice lawsuits is a familiar one within the United States legal framework. The intricate design of the legal system encourages in-depth exploration and dialogue between opposing parties, striving to resolve disputes through negotiation rather than resorting to a jury trial.

For a medical malpractice claim to succeed, the burden rests on the injured patient to demonstrate that the physician’s conduct was marked by negligence in the provision of care, which in turn resulted in harm. To construct this case, a meticulous establishment of four key legal elements is imperative:

Professional Duty: The first pillar requires illustrating that the medical professional held a duty of care toward the patient, an obligation to provide treatment up to a certain standard.
Breach of Duty: The subsequent element hinges on showcasing the breach of this established duty—a deviation from the standard of care that a prudent medical practitioner would uphold.
Injury and Causation: To solidify the case, a clear link between the breach of duty and the injury suffered by the patient must be demonstrated, establishing causation as a pivotal factor.
Damages: The final dimension centers on the impact of the breach and its aftermath, encompassing the resulting damages. Monetary compensation, when awarded, often encompasses both quantifiable economic losses and intangible noneconomic losses, such as the enduring anguish of pain and suffering.

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In the realm of medical malpractice law, the pursuit of justice involves navigating these intricacies, illuminating the connections between duty, breach, injury, and damages. It is through this intricate dance of legal elements that the scales of justice strive to uphold the rights and interests of those who have suffered due to medical negligence.

Introduction

The fundamental principle that individuals entering a learned profession commit to exercising a reasonable degree of care and skill traces its origins back to ancient Rome and England. The roots of discourse on medical responsibility can be traced back to 2030 BC, where the Code of Hammurabi outlined consequences for medical actions leading to harm. For instance, the Code stated that a physician causing a gentleman’s death through medical treatment with a bronze lancet should face punitive measures, such as the severing of hands.

In the realm of Roman law, medical malpractice was a recognized legal transgression. The dissemination of Roman law to continental Europe around 1200 AD fostered the expansion of these legal concepts. After the Norman conquest of 1066, English common law took shape. During the reign of Richard Coeur de Lion in the late 12th century, records were meticulously kept in the Court of Common Law and the Plea Rolls. This historical archive chronicles an unbroken lineage of medical malpractice rulings that extend to modern times. Notably, an early English case established the precedent that both a servant and their master could seek damages against a doctor who had worsened the servant’s condition through unwholesome treatment. The year 1532 marked a turning point during the reign of Charles V, as a law mandating the formal involvement of medical experts in cases of violent death emerged, prefiguring the requirement for expert testimony in medical negligence claims to establish the standard of care.

In the United States, the emergence of medical malpractice suits gained momentum in the 1800s. However, prior to the 1960s, such claims were infrequent and exerted minimal influence on medical practice. Subsequently, the 1960s witnessed a surge in medical malpractice claims, with lawsuits filed by patients alleging physician malpractice becoming a common occurrence in the United States. A survey conducted among specialty arthroplasty surgeons revealed that over 70% of respondents had faced at least one medical malpractice lawsuit during their careers.

Given the ubiquity of medical malpractice litigation, it’s probable that surgeons will encounter it during their professional journey. When a lawsuit is initiated, physicians who become defendants must navigate unfamiliar legal terrain characterized by distinct objectives, professional practices, and procedures that diverge from the medical field. This article seeks to equip orthopaedic surgeons with an initial understanding of essential medical malpractice law concepts. This includes an exploration of the terminology, court structure, and adjudicative bodies that oversee medical malpractice litigation within the United States. Through this exploration, the article aims to empower orthopaedic surgeons with foundational insights into the intricate realm of medical malpractice law.

Medical Malpractice Law in the United States

In the United States, the framework of medical malpractice law is rooted in the jurisdiction of individual states, setting it apart from many other nations where federal authority plays a greater role. The pursuit of monetary compensation for injuries resulting from medical negligence necessitates the patient’s ability to substantiate that substandard medical care led to harm. This assertion of medical negligence must be lodged within a stipulated timeframe, known as the “statute of limitations,” which varies across states. Once the link between negligence and injury is established, the court assesses the monetary damages that warrant compensation. These damages encompass both quantifiable economic loss such as lost earnings and anticipated future medical expenses, alongside intangible losses like pain and suffering. Medical practitioners in the United States typically carry medical malpractice insurance, safeguarding them against potential claims arising from negligence and unintended harm. In some instances, such insurance is mandated for obtaining hospital privileges or affiliation with a medical group.

Medical malpractice is defined as any action or omission by a physician during patient treatment that deviates from accepted norms within the medical community, resulting in patient injury. It resides within the realm of tort law, a subset of law concerned with professional negligence. “Tort,” originating from the Norman word for “wrong,” denotes a body of law that establishes remedies for civil wrongs distinct from contractual obligations or criminal offenses. Within this context, “negligence” is broadly defined as behavior falling short of an established standard. In tort law, the commonly employed standard is that of a “reasonable person.” This legal construct conceptualizes the conduct an average person in comparable circumstances would undertake or refrain from to shield another individual from foreseeable harm.

The evolution of contemporary medical malpractice law traces back to 19th-century English common law. Common law, forming the legal basis for England and Wales, has been exported to the United States and various other Commonwealth countries during the era of the British Empire. It denotes laws and legal systems that develop through court decisions, diverging from statutes or executive decrees. Within the United States, medical malpractice law is governed by state authorities, shaped by court rulings stemming from state-level lawsuits. Consequently, state-specific regulations governing medical malpractice can differ across jurisdictions, even though the core principles are analogous. Additionally, legislative statutes enacted by states over the past three decades have further contributed to shaping medical malpractice law. Thus, the foundation of medical malpractice law in the United States rests on common law, nuanced by state legislative actions that exhibit variation.

An exception to medical liability emerges in scenarios where individuals voluntarily provide aid to others in need. This exception is embodied in “Good Samaritan” laws, which address concerns of bystanders being susceptible to lawsuits or prosecution for unintentional injuries or wrongful deaths. In the United States, Good Samaritan laws vary among jurisdictions, specifying who is protected and under what circumstances. While Good Samaritan statutes generally do not compel assistance to victims, a handful of states, including Vermont and Minnesota, outline an obligation to offer reasonable aid to injured individuals during emergencies. This obligation can be fulfilled by contacting emergency services. Breaching this duty is usually a minor offense.

Although the application of Good Samaritan provisions is not uniform, they share certain common principles. The principle of imminent peril influences the scope of such laws. If a bystander intervenes without imminent peril, causing harm, their actions may be deemed reckless. Once assistance is initiated, the responder should not leave unless relieved by another helper, unless medical attention is necessary, or if continuing aid is unsafe. In emergency situations, consent is assumed if the patient is incapacitated; courts typically view such situations leniently under the principle that “peril invites rescue.”

In summary, where applicable, and within the confines of specific jurisdictions, Good Samaritan laws can shield responders from legal culpability for victim death, disfigurement, or disability, as long as the actions are conducted in good faith, align with their training level, and exhibit rationality. In certain jurisdictions, protection extends solely to individuals who possess basic first aid training and certification from a health organization, provided they stay within their training’s scope. In such cases, untrained individuals providing incorrect first aid can be held accountable for errors. Conversely, in other jurisdictions, any responder acting rationally is exempt from legal liability.

The Judicial System in the United States

While the nomenclature of various judicial bodies may differ, the court structure and hierarchy across states maintain a consistent pattern. All U.S. states feature trial courts handling civil disputes, supplemented by systems of appellate courts, ultimately culminating in the state supreme court as the final judicial authority. The determination of the court’s location, termed “venue,” and jurisdiction—its legal authority to adjudicate the case—are influenced by the parties’ residence and the site of alleged misconduct. Filing a case in the wrong court can lead to dismissal due to improper venue.

Medical malpractice lawsuits are generally initiated in state trial courts, holding jurisdiction over such cases. Each state follows distinct legal guidelines governing venue and jurisdiction. Some locales may span two judicial districts, granting plaintiffs the flexibility to file suits in multiple trial courts. If the malpractice claim involves the federal government via federally funded clinics or Veterans Administration facilities, it is presented in a federal district court. Every state houses at least one such federal district court. Federal courts are also suitable for cases involving diverse state citizenship or federal issues, such as potential violations of fundamental constitutional rights during alleged negligence.

In the United States, the right to a trial by jury is regarded as a fundamental constitutional entitlement. Jury trials entail a panel of individuals drawn from the public who assess presented evidence and reach a verdict. Jury selection adheres to court regulations, facilitated by attorneys from both sides. Juror demographics are disclosed to both parties, each of whom can eliminate a limited number of jurors to ensure impartiality. Unlike a jury trial, a bench trial is resolved by a judge or panel of judges. Medical malpractice cases in the U.S. typically involve a jury trial, provided the case isn’t resolved before trial. (It’s important to differentiate a jury trial from a grand jury, which addresses criminal indictments and doesn’t apply to medical malpractice cases.)

Under specific circumstances, a medical malpractice case may be initiated or transferred to a federal court. This occurs when the case involves federal questions, constitutional issues, or parties residing in different states. The U.S. federal court system comprises 94 district courts—one in each state. Like state courts, U.S. district courts consist of a judge and jury panel to preside over cases. While federal courts adhere to distinctive procedural rules, they closely resemble state legal procedures. The substantive law applied by federal courts to resolve disputes derives from the state where the district court is located, encompassing statutory law and legal precedents. Thus, even in federal court trials, state malpractice law applies alongside federal procedural rules, governing litigation processes and legal proceedings.

The Legal Framework in the United States

The legal framework governing civil dispute resolution in the United States follows the adversarial system, where advocates for opposing sides skillfully present arguments before an impartial entity, like a jury or judge, to reach a resolution [19]. This approach, also employed in other common law countries, serves to address claims related to negligence, be it in medical contexts or beyond. In contrast, the inquisitorial system, prevalent in continental European nations rooted in the civil law system based on Roman or Napoleonic code, involves judges independently investigating facts and rendering decisions. The Napoleonic code, originating from the French civil code established under Napoleon Bonaparte in 1804, emphasized clear and accessible laws, significantly shaping the notion of the “rule of law.” Rooted in prior French and Roman laws, this code was pivotal in reforming France’s civil law system and influencing legal systems globally.

The patient who brings a lawsuit before the court is termed the plaintiff or complainant. By initiating the lawsuit, the plaintiff seeks a legal remedy from the court. In case of success, the court issues judgment for the plaintiff and a court order for damages. The defendant is the party facing the complaint. In medical malpractice, this is the physician, medical facility, hospital, or professional organization connected to the physician. Legal cases are identified by citing the plaintiff first; therefore, a lawsuit is denoted as “Plaintiff v. Defendant.”

A medical malpractice lawsuit in the United States begins with the submission of legal documents like a summons, claim form, or complaint, collectively known as pleadings. These pleadings outline alleged wrongdoings by the defendant physician, accompanied by a plea for relief. In certain jurisdictions, legal proceedings commence with the defendant being served legal documents through a process server. These documents are then filed with the court, complete with an affidavit confirming their delivery to the defendant physician in accordance with specified legal procedures.