A court dismissed a nursing negligence lawsuit against a nurse practitioner (NP) because the plaintiff couldn’t prove causation, a critical legal element in negligence cases. While the court acknowledged a lapse in the standard of care, that alone wasn’t enough.
Here’s how the timeline unfolded and why the claim fell short.
Timeline: The patient’s visits and missed diagnosis
- A male patient visited a federally funded clinic, complaining of painful and frequent urination, a weak urine stream, and lower back pain, which he attributed to kidney issues.
- A nurse practitioner evaluated him, conducted several tests, and diagnosed him with benign prostatic hyperplasia and sciatica. She prescribed tamsulosin and recommended a follow-up visit in four weeks.
- The patient didn’t return until several months later, reporting symptom improvement. Lab results were unremarkable. The NP renewed his prescription and scheduled a six-month follow-up.
- Slightly after the six-month mark, the patient returned, reporting a cough and night sweats. The NP didn’t evaluate him during this visit.
- Subsequently, the patient was diagnosed with kidney cancer and died seven months later.
Why the case was filed and how the court responded
Given the clinic's federal funding, the lawsuit was filed under the Federal Tort Claims Act (FTCA), which allows patients to sue the U.S. government for negligence by federal employees. It’s based on the legal doctrine of respondeat superior, meaning an employer is responsible for actions taken by employees within the scope of their duties.
The estate of the deceased patient claimed the NP was professionally negligent, arguing:
- She should’ve ordered further diagnostic tests during the earlier visits.
- Earlier detection could’ve led to timely treatment, reducing suffering and potentially preventing death.
The U.S., defending the case, filed a Motion for Summary Judgment.
The court’s analysis
Both sides agreed that Illinois law applied, as the incident occurred there. Under Illinois law, a plaintiff must prove:
- The healthcare provider breached the standard of care.
- This breach directly caused the patient's injury.
The U.S. conceded that the NP didn’t meet the standard of care by failing to order specific tests. It also agreed that earlier intervention might have led to a better outcome if the cancer had been detected and treated earlier.
But the estate’s expert witnesses didn’t establish that a referral to a urologist would’ve occurred, even if those tests had been ordered. Without that link, the court said any connection between the NP’s breach and the patient’s outcome was speculative.
The court rejected the estate’s argument that causation could be assumed. Consequently, the court granted summary judgment in favor of the U.S.
What nurses need to understand from the outcome
This situation illustrates how negligence cases depend on meeting every element of the legal standard.
Even when a breach in the standard of care is evident, without a direct connection to the patient's harm, a claim may not succeed.
Remember: The legal doctrine of respondeat superior was central here. Though the estate sued the U.S., not the individual NP, plaintiffs have the right to sue an individual nurse, their employer, or both.
Practical advice for nursing professionals
From this case, several reminders stand out:
- Maintain professional liability insurance. It covers legal defense and any judgment up to the policy limit. Without it, you shoulder all legal costs yourself.
- Consult when uncertain. If you're unsure about a patient's condition, consult your supervising physician (if applicable) or team members to determine the appropriate course of action, which may include ordering diagnostic tests or referrals.
- Follow your specialty’s standards of practice. Staying informed and connected through professional groups, like the American Association of Nurse Practitioners, keeps your practice current.
- Document clearly and thoroughly. Thorough documentation of care, prescriptions, and interventions is important for patient care. It can also be a deciding factor if your care is ever questioned in a lawsuit or professional disciplinary action.
Bottom line
Legal outcomes hinge on meeting all required elements. The dismissal of this nurse malpractice claim highlights the critical role of causation in medical negligence cases. For nursing professionals, it serves as a reminder of the importance of thorough documentation, adherence to standards of care, and proactive consultation when faced with uncertain clinical situations.
