CACI No. 500. Medical Negligence - Essential Factual Elements

Judicial Council of California Civil Jury Instructions (2023 edition)

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500.Medical Negligence - Essential Factual Elements
Please see CACI No. 400, Negligence - Essential Factual Elements
New September 2003; Revised December 2011, December 2015
Directions for Use
In medical malpractice or professional negligence cases, the word “medical” or
“professional” should be added before the word “negligence” in the first paragraph
of CACI No. 400. From a theoretical standpoint, medical negligence is still
considered negligence. (See Flowers v. Torrance Memorial Hospital Medical Center
(1994) 8 Cal.4th 992, 997-998 [35 Cal.Rptr.2d 685, 884 P.2d 142].)
Also give the appropriate standard-of-care instruction for the defendant’s category of
medical professional. (See CACI No. 501, Standard of Care for Health Care
Professionals, CACI No. 502, Standard of Care for Medical Specialists, CACI No.
504, Standard of Care for Nurses, CACI No. 514, Duty of Hospital.)
It is not necessary to instruct that causation must be proven within a reasonable
medical probability based upon competent expert testimony. The reference to
“medical probability” in medical malpractice cases is no more than a recognition
that the case involves the use of medical evidence. (Uriell v. Regents of University
of California (2015) 234 Cal.App.4th 735, 746 [184 Cal.Rptr.3d 79].)
Sources and Authority
“Professional Negligence” of Health Care Provider Defined. Code of Civil
Procedure section 340.5, Civil Code sections 3333.1 and 3333.2.
“The elements of a cause of action for medical malpractice are: (1) a duty to use
such skill, prudence, and diligence as other members of the profession
commonly possess and exercise; (2) a breach of the duty; (3) a proximate causal
connection between the negligent conduct and the injury; and (4) resulting loss
or damage.” (Lattimore v. Dickey (2015) 239 Cal.App.4th 959, 968 [191
Cal.Rptr.3d 766].)
“The court’s use of standard jury instructions for the essential elements of
negligence, including causation, was appropriate because medical negligence is
fundamentally negligence.” (Uriell, supra, 234 Cal.App.4th at p. 744 [citing
Directions for Use to this instruction].)
“Section 340.5 defines ‘professional negligence’ as ‘a negligent act or omission
by a health care provider in the rendering of professional services, which act or
omission is the proximate cause of a personal injury or wrongful death, provided
that such services are within the scope of services for which the provider is
licensed and which are not within any restriction imposed by the licensing
agency or licensed hospital.’ The term ‘professional negligence’ encompasses
actions in which ‘the injury for which damages are sought is directly related to
the professional services provided by the health care provider or directly related
to ‘a matter that is an ordinary and usual part of medical professional services.’
‘[C]ourts have broadly construed “professional negligence” to mean negligence
occurring during the rendering of services for which the health care provider is
licensed.’ (Arroyo v. Plosay (2014) 225 Cal.App.4th 279, 297 [170 Cal.Rptr.3d
125], original italics, internal citations omitted.)
“With respect to professionals, their specialized education and training do not
serve to impose an increased duty of care but rather are considered additional
‘circumstances’ relevant to an overall assessment of what constitutes ‘ordinary
prudence’ in a particular situation.” (Flowers,supra, 8 Cal.4th at pp. 997-998.)
“Since the standard of care remains constant in terms of ‘ordinary prudence,’ it
is clear that denominating a cause of action as one for ‘professional negligence’
does not transmute its underlying character. For substantive purposes, it merely
serves to establish the basis by which ‘ordinary prudence’ will be calculated and
the defendant’s conduct evaluated.” (Flowers, supra, 8 Cal.4th at p. 998.)
“The Medical Injury Compensation Reform Act (MICRA) contains numerous
provisions effecting substantial changes in negligence actions against health care
providers, including a limitation on noneconomic damages, elimination of the
collateral source rule as well as preclusion of subrogation in most instances, and
authorization for periodic payments of future damages in excess of $ 50,000.
While in each instance the statutory scheme has altered a significant aspect of
claims for medical malpractice, such as the measure of the defendant’s liability
for damages or the admissibility of evidence, the fundamental substance of such
actions on the issues of duty, standard of care, breach, and causation remains
unaffected.” (Flowers,supra, 8 Cal.4th at p. 999.)
“On causation, the plaintiff must establish ‘it is more probable than not the
negligent act was a cause-in-fact of the plaintiff’s injury.’ “A possible cause
only becomes ‘probable’ when, in the absence of other reasonable causal
explanations, it becomes more likely than not that the injury was a result of its
action.” ‘[C]ausation in actions arising from medical negligence must be proven
within a reasonable medical probability based on competent expert testimony,
i.e., something more than a “50-50 possibility.” ‘[T]he evidence must be
sufficient to allow the jury to infer that in the absence of the defendant’s
negligence, there was a reasonable medical probability the plaintiff would have
obtained a better result.’ (Belfiore-Braman v. Rotenberg (2018) 25 Cal.App.5th
234, 247 [235 Cal.Rptr.3d 629], internal citations omitted.)
“That there is a distinction between a reasonable medical ‘probability’ and a
medical ‘possibility’ needs little discussion. There can be many possible ‘causes,’
indeed, an infinite number of circumstances which can produce an injury or
disease. A possible cause only becomes ‘probable’ when, in the absence of other
reasonable causal explanations, it becomes more likely than not that the injury
was a result of its action. This is the outer limit of inference upon which an
issue may be submitted to the jury.” (Jennings v. Palomar Pomerado Health
Systems, Inc. (2003) 114 Cal.App.4th 1108, 1118 [8 Cal.Rptr.3d 363], original
italics, internal citations omitted.)
“The rationale advanced by the hospital is that . . . if the need for restraint is
‘obvious to all,’ the failure to restrain is ordinary negligence. . . . [T]his
standard is incompatible with the subsequently enacted statutory definition of
professional negligence, which focuses on whether the negligence occurs in the
rendering of professional services, rather than whether a high or low level of
skill is required. [Citation.]” (Bellamy v. Appellate Dep’t of the Superior Court
(1996) 50 Cal.App.4th 797, 806-807 [57 Cal.Rptr.2d 894].)
“[E]ven in the absence of a physician-patient relationship, a physician has
liability to an examinee for negligence or professional malpractice for injuries
incurred during the examination itself.” (Mero v. Sadoff (1995) 31 Cal.App.4th
1466, 1478 [37 Cal.Rptr.2d 769].)
Secondary Sources
6 Witkin, Summary of California Law (11th ed. 2017) Torts, §§ 1066-1068, 1071,
California Tort Guide (Cont.Ed.Bar 3d ed.) § 9.65
3 Levy et al., California Torts, Ch. 30, General Principles of Liability of
Professionals, § 30.11, Ch. 31, Liability of Physicians and Other Medical
Practitioners, § 31.01 (Matthew Bender)
17 California Forms of Pleading and Practice, Ch. 209, Dentists, § 209.15 (Matthew
27 California Forms of Pleading and Practice, Ch. 295, Hospitals, §§ 295.13, 295.43
(Matthew Bender)
36 California Forms of Pleading and Practice, Ch. 415, Physicians: Medical
Malpractice, § 415.11 (Matthew Bender)
17 California Points and Authorities, Ch. 175, Physicians and Surgeons, § 175.20 et
seq. (Matthew Bender)

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