The
attorney must help the jury to recognize the causal link between
the negligent
act and the resulting injury. Below is a brief description and
graph of a case used
to illustrate causation.
This case involved a woman in her mid 50s with chest
pain who presented to
the ER twice in three
days and was admitted with a diagnosis of gastrointestinal
distress. Despite appropriate testing and treatment that
provided evidence her
chest pain was of cardiac origin, on day 4 the doctor discharged
the patient
home with medications to alleviate "heart burn".
Six hours later the patient
died from a massive heart attack.
In
analyzing the medical data, it became clear the patient's
pain was consistently
relieved each time the nurse administered nitroglycerin, a cardiac
specific
medication that dilates blood vessels in the heart, increasing
blood flow, thus
relieving the blood starved heart muscle. Despite this evidence, the doctor,
already convinced that the
pain was from indigestion, ignored the evidence
and discharged the patient home.
The defendant doctor argued the patient did not
demonstrate a classic
cardiac
condition. To the
contrary, we were able to show the woman responded
classically to a fundamental and specific treatment for relief
of cardiac origin
chest pain. The
graph above was developed to illustrate
the key evidence
in this case; the correlation between nitroglycerin treatment and the patient's
immediate pain relief.
The black triangle data points on the graph
indicate the patient's self reported
pain intensity before medication. The white
square data points on the graph
indicate the level of pain after medication.
At
22:30 on 1/11, the triangle and square data points are in close proximity to
one another, illustrating the pain level was unchanged
after administration of the
antacid. Therefore the treatment was ineffective.
At
21:50 on 1/16, the patient received the first dose of nitroglycerin. The data
points are separated with the square data point at zero,
illustrating the treatment
alleviated the patient's pain.
The nitroglycerin relieved her pain the first time it was
given and each time thereafter.
At 15:40 on 1/17, the patient was discharged home
with a reported chest pain level of 6.
The patient died at home six hours later from
a massive heart attack. This case settled in mediation.
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