Matsuyama v. Birnbaum: Standard of Care and Loss of Chance

Introduction to Matsuyama v. Birnbaum

The tort case examined here is Matsuyama v. Birnbaum, a wrongful death action involving a healthcare defendant. This is a particularly interesting case because medical malpractice suits of various types are frequently cited as contributing factors in the high cost of healthcare in the United States. The case relates to the standard of care doctrine, wherein the medical practitioner was accused of failing to deliver an acceptable standard of care and of causing the patient's death through that failure. At issue was the use of medical expert testimony to determine whether the physician met the acceptable standard of care — a critical question in any malpractice tort case. The methodology by which that standard is established was one of the key issues in the litigation.

The Standard of Care Doctrine

The standard of care doctrine was the central legal benchmark by which this case was judged, as is common in tort law. A professional must provide a reasonable standard of care that, in medicine, is grounded in evidence and established practice. Expert testimony is frequently used to establish the baseline for what an accepted standard of care looks like in a given clinical situation.

Recent rulings have shifted this standard somewhat: a doctor's negligence cannot reduce a patient's chance of recovery, even when that chance was initially relatively low. Traditionally, if a patient had less than a 50% chance of recovery, an award was unlikely. More recent rulings have changed this, allowing any patient whose chance at recovery was diminished by negligence to sue and recover damages. This principle is known as the loss of chance doctrine, and it is now available in malpractice suits under tort law (Jayasankar & Curi, 2010).

Tort Reform Considerations

The result of this case does not suggest a need for tort reform, though it does have some explanatory power for why healthcare costs are as high as they are. Tort reform would be warranted only if something about this case failed to make sense when its principles were extrapolated across a large sample — no single case can serve as meaningful evidence of the need for systemic reform. The loss of chance doctrine is quite meaningful where it complements the standard of care doctrine: medical practitioners are bound to a certain standard of care that includes ensuring patients are tested for all possibilities that could reasonably arise, particularly when those possibilities are serious in nature.

There is a legitimate question, however, about whether tort reform could enforce a different method of defining an acceptable standard of care. In some fields, this might be relatively straightforward without relying on expert testimony for every case. In medicine, it is far less clear that tort reform would help. Each patient is different; they present differently, and these individual differences make it difficult to write standard of care guidelines that are specific to every situation. There is inherent risk in the current system of determining a standard of care in hindsight, but treating patients is not the same as a routine manufacturing task. Determining an acceptable standard of care in non-routine situations is imperfect, but the nature of unique clinical situations means there is no meaningful way to predetermine a standard of care in advance. The doctrine, for all its faults, remains the best available approach. At most, loose guidelines could be published for the more common situations physicians face, but that would not fully resolve the challenges posed by the standard of care doctrine in non-routine cases.

References

Jayasankar, S. & Curi, S. (2010). Loss of chance in medical liability. American Academy of Orthopaedic Surgeons. Retrieved October 5, 2015, from