HW Legal
The case concerned a patient who had suffered a very serious injury to his left leg. Immediately after the accident, he was taken to hospital, where he underwent surgery to repair a severed artery.
However, the subsequent post-operative care was inadequate. The doctors failed to verify the patency of the operated artery. An ultrasound examination was not performed until several hours later, and there was also a significant delay before revision surgery was carried out. In the meantime, irreversible tissue damage and compartment syndrome developed in the affected limb. The leg ultimately had to be amputated.
The courts concluded that the hospital's post-operative care was non lege artis, i.e. medically improper. The period of ischaemia lasted approximately ten hours, reaching a duration after which irreversible tissue necrosis demonstrably occurs. It was therefore established that the hospital had committed an error which, in itself, was capable of resulting in the need for amputation.
Burden of proof in a medical malpractice claim against a hospital
One of the most difficult issues in claims for compensation for harm caused by medical care is establishing causation. As a rule, it is not sufficient merely to establish that a doctor or hospital made an error. For liability for harm to a patient's health to arise, there must also be a causal link between the non lege artis treatment and the harm suffered by the patient.
Medical malpractice disputes are, however, specific in that the development of a patient's medical condition is affected by numerous biological and other factors. It may therefore be impossible to determine retrospectively with absolute certainty how the patient's condition would have developed had the medical professionals acted correctly. In this context, the Czech Supreme Court also accepts expert conclusions expressed in terms of probability and does not always require causation between the treatment and the harm to be established with absolute certainty.
We have previously discussed the burden of proof in medical malpractice disputes here.
When does the hospital have to prove the cause of the harm?
In this case, the Czech Supreme Court emphasised an important rule concerning the burden of proof where a healthcare provider has made an error. As a general rule, including in medical malpractice disputes, the burden of proving a particular fact rests with the party who seeks to derive favourable legal consequences from that fact. It is therefore the patient (the claimant) who must prove the occurrence of harm and the healthcare provider's error.
However, if the hospital claims that the patient's harm was caused, wholly or in part, by other circumstances for which it is not responsible, it is the hospital that must prove those circumstances.
In this case, it had already been established that the hospital had acted non lege artis and that its error was, in itself, capable of causing compartment syndrome leading to the amputation of the limb. In those circumstances, the patient was no longer required to prove that the improperly provided medical care was the sole or predominant cause of the amputation.
If the hospital claims that it is not liable for the resulting harm, it must instead prove that the predominant or sole cause of the harm was another circumstance beyond its control. In other words, it must prove that the amputation would have been necessary even if the medical care had been provided properly and without error.
What does the decision mean for patients harmed by improper medical treatment?
The Czech Supreme Court's decision is significant for patients seeking compensation for medical malpractice or hospital negligence.
It does not mean that the burden of proof is automatically reversed in every dispute with a hospital, requiring the hospital to prove that it acted correctly. The Supreme Court did, however, clarify the following principle: where a patient proves that an error occurred in the provision of medical care and that the error was, in itself, capable of causing the harm suffered, the healthcare provider cannot avoid liability merely by pointing to the possibility that the adverse health outcome may also have had another cause.
If the hospital claims that the harm to the patient's health would have occurred even without its error, the hospital must prove that assertion.
What was the outcome of the case? The Supreme Court set aside the decision of the appellate court, which had dismissed the patient's claim, and remitted the case to it for further proceedings. In those proceedings, it will be for the hospital to prove that the patient's leg would have had to be amputated even if proper post-operative care had been provided.
Compensation for medical malpractice and hospital negligence
A patient who suffers harm to their health as a result of improperly provided medical care may, subject to the applicable legal requirements, seek compensation for that harm. We have previously discussed the types of compensation available for personal injury here.
In medical malpractice disputes, the key issues typically include an assessment of whether the treatment was provided lege artis, the patient's medical records, expert evidence and the causal link between the healthcare provider's error and the resulting harm to the patient's health.
If you believe that you have suffered harm as a result of a medical error, delayed diagnosis, improper treatment or other negligence by a doctor or hospital, we recommend seeking legal advice. Get in touch with us – we will be happy to discuss your case with you and advise you on the next steps.