Accident at Hospital Highlights Importance of Causality Proof (But-For Test)

In personal injury cases, there are a number of elements that must be met in order to be successful in a lawsuit. First, a plaintiff must show that they were owed a duty of care by the other party. Second, they must show that there was a breach of that duty of care. Third, there must be actual harm resulting from the breach of that duty of care. Fourth, and most importantly, the harm must be caused by the breaching party. Causation may seem easy to understand on its face, but in lawsuits it can become a very complex matter where the entire result can hinge on this very element.
Typically, the plaintiff carries the burden to prove that her injuries are actually caused by the defendant. One usual method of establishing factual causation is the “but-for” test. The test inquires: ‘but for’ defendant’s actions, would the harm to the plaintiff have occurred?” If the answer is “no,” then the plaintiff fails to prove causation, because the defendant’s act is not necessary to cause her injuries.   

Let’s consider the following scenario: a lady went to a hospital to visit her grandson. She sat on a sofa bed while waiting in the emergency room. Unfortunately, because the springs that hold the supporting tarp for the sofa bed were missing, the lady fell through the sofa bed onto the floor. As a result, she suffered severe back injuries that ultimately required surgeries.

Using the ‘but-for’ test, we can conclude that the lady’s harm was caused by the hospital’s negligent act by having a defective sofa bed. Had the springs not been missing, she would not have fallen through the sofa bed. However, in many real-world situations, establishing causation is far more complex. One factor in causation that can further complicate causation is a defendant’s pre-existing condition.

The above scenario is a simplified version of a recent case decided by the Louisiana Court of Appeals: Mrs. Crooks was the lady harmed by the defective sofa bed at Lake Charles Memorial Hospital. On appeal, the hospital defendant contended that Mrs. Crooks failed to prove that she was actually injured by falling through the sofa bed. The defendant pointed to the medical history of Mrs. Crooks. According to her medical record, she frequently suffered from neck pains and occasionally lower back pains even prior to the falling incident. In addition, Mrs. Crooks also underwent two neck surgeries prior to the accident.

Here the complication for proving factual causation is Mrs. Crooks’s pre-existing medical condition. The hospital was essentially arguing that the accident was not a “but for” cause for the injuries. Even if the accident had not occurred, Mrs. Crooks would probably still suffer from back pains and need future surgeries. Therefore, it is not enough for Mrs. Crooks to merely show that she experienced neck pain after the accident. She has to further prove that falling through the sofa bed exacerbated her pre-existing condition or led to some new injuries. In this case, several doctors and medical experts testified that the accident, more probable than not, caused Mrs. Crooks to undergo surgery.

In conclusion, establishing factual causation in personal injury disputes is far more complicated when the defendant has a pre-existing condition. In these situations, simply showing the defendant was the but-for cause of the plaintiff’s injury may not always be enough. The defendant must go above and beyond to prove that her pre-existing condition has been exacerbated by the negligence of the plaintiff in order to successfully prevail in an action.