Frequently, cases of clear negligence founder on causation. Symptoms and disability that the client reports as occurring de novo may be part of a pre-injury pattern, or result from unrelated disease processes. It is unusual for expert opinion to endorse the view that poor result means substandard care.
Frequency, cases of clear negligence founder on causation. All too often, demonstrably substandard care cannot be causally connected to the adverse outcome. A common example is a malignancy that had no better prognosis when the diagnosis was missed than when it was eventually made.
Similarly, many traditional therapies are purely symptomatic and have no fundamental influence on the disease process: diagnosis and medical treatment of Crohn's Disease would fall into this category. There is currently no medical therapy that influences the progression of the disease. Similarly, delays in the undertaking of radical surgery may result in a period of avoidable pain and suffering, but there may be no demonstrable effect of the postponement on the subsequent disability or postoperative symptoms.
Symptoms and disability that the client reports as occurring de novo may be part of a pre-injury pattern, or result from unrelated disease processes. Frequently, the only pathological basis for some of the long-term symptoms may be somatoform disorder and the negligent event may have been demonstrably unnecessary or insufficient, on balance of probability.
When the relationships between the principal sources of quantum and putatively substandard care are simpler and more proximate, medical causation is more frequently proven.
It is unusual for expert opinion to endorse the view that poor result means substandard care. Rarely will res ipsa loquitur apply if expert medical opinion is required to prove negligence. That is to say, it is exceptional for an adverse outcome to be attributable to negligence for which there is little or no independent medical evidence. The principle of res ipsa loquitur is widely misapplied in ill-considered Statements of Claim.
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