Physicians Challenge Malpractice Suit By Sacramento Woman, Part 5 of 6

The following blog entry is written from a defendant’s position as trial approaches. Reviewing this kind of briefing should help potential plaintiffs and clients better understand how parties in personal injury cases present such issues to the court.

(Please note: the names and locations of all parties have been changed to protect the confidentiality of the participants in this medical malpractice/personal injury case and its proceedings.)


CACI 430 defines causation as more than a remote or trivial fact. This, however, is not the correct definition of causation in a medical malpractice action. Pursuant to case law, causation in a medical malpractice action, must be shown to a reasonable medical probability. Alef v. Alta Bates Hospital (1992) 5 Cal.App.4th 208. Further, the evidence must be sufficient to allow a jury to infer that in the absence of the defendant’s negligence there was a reasonable medical probability that the plaintiff would have obtained a better result. Id. at 216.

Accordingly, based upon the above argument regarding causation, CACI 430, which defines substantial factor only as a factor that a reasonable person would consider to have contributed to the harm or more than a remote or trivial fact fails to address the necessary reasonable medical probability, and as such, is inherently misleading, incomplete, and a misstatement of the applicable law on causation for this matter.

In addition, CACI 430 allows a reasonable person to determine whether a factor contributed to the alleged harm. However, in medical negligence actions, the laws do not support this reasonable person standard. In medical negligence actions, evidence of causation must be based upon competent expert testimony. Bromme v. Pavitt (1992) 5 Cal.App.4th 1487; Landeros v. Flood (1976) 17 Cal.3d 399; Jambazian v. Borden, (1994) 25 Cal.App.4th 836, at 844.

The rationale for requiring expert testimony in medical malpractice actions was succinctly stated by the court in Barton v. Owen (1977) 71 Cal.App.3d 484: Inmost instances, there is a need for expert testimony on the subject of just what constitutes medical negligence, because the average judge or juror does not possess the necessary level of knowledge about medical malpractice to decide on its own whether the doctor was negligent. (Barton, supra, at 493.) Contrary to Bromme v. Pavitt (1992) 5 Cal.App.4th 1487, Landeros v. Flood (1976) 17 Cal.3d 399, Jambazian v. Borden, (1994) 25 Cal.App.4th 836, and Jones v. Ortho Pharmaceutical Corp (1985) 163 Cal.App.3d 396, CACI 430 mistakenly states that causation may be proven by what a reasonable person would consider to be a substantial factor in causing harm. CACI 430 makes no mention of the necessary competent expert testimony necessary to prove causation. Therefore, with regard to this medical negligence action, Defendants contend that the CACI 430 instruction is a clear misstatement of the current law governing causation in a medical negligence cause of action, and thus, it would be an error to instruct the jury to use CACI 430 to define causation in this matter. (See Part 6 of 6.)

For more information you are welcome to contact Sacramento personal injury lawyer, Moseley Collins.

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