LNCtips.com: What Difference Did it Make?
Legal nurse consultants are usually astute about determining deviations from standards of care. LNCs are also readily able to discern damages. However, identifying causation, one of the four elements of medical malpractice, is sometimes harder for LNCs to analyze. Here's an easy way to determine causation. Ask yourself, "What difference did it make?"
As a refresher, the four elements of medical malpractice are Duty, Breach of Duty, Causation, and Damages. Causation is the connection between medical carelessness (breach of duty) and patient injury (damages). If there is carelessness but no injury, there's no causation. If there is an injury but no carelessness, there's no causation. Let's look at some examples to see if lapses in care caused damages.
| Lapse in Care? |
Damages? |
What Difference Did
it Make? |
| The nurse administers Colace two hours
later than scheduled. |
The patient has a lethal myocardial infarction an hour after administration of the Colace. | Even though there was a deviation in the standard of care (administration of the stool softener two hours late), and damages (the MI) the lapse made no difference in the development of the MI; the two are unrelated. Therefore, there is no causation. |
| An ER nurse irrigates
and dresses a deep laceration of a patient's
right hand. The nurse performs the irrigation and
dressing according to the physician's order and hospital
policy. |
The patient develops an
infection of the wound site and ultimately
loses the use of his hand. |
Since the nurse's actions were
appropriate, they did not make a difference in the
development of the patient's infection. Thus,
there is no causation.
However, sometimes the patient's recollection of events ("Her hands were dirty!") will indicate causation even if the medical records don't suggest a problem. |
| A nursing assistant leaves a frail
patient with dementia
on the toilet. |
The patient gets up from the toilet,
urinates on the floor, slips on the wet floor, and breaks her hip. |
What difference did it make that the CNA
left the patient alone? In this case, the damages
of a broken hip are clearly due to the CNA's
actions. Therefore,
there is causation. |
That's all there is to it. The next time you're wondering about Causation, ask yourself, "What difference did it make?"
...Katy Jones