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Here’s What You Need To Know About Pre-existing Conditions In Medical Malpractice

Written by Berkowitz

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Health care providers make mistakes, just like everyone else. However, since errors in the medical setting can often have devastating effects on patients and their families, Connecticut law holds health care providers to a high standard of care. If a provider fails to uphold this standard of care, the provider can – and should – be held liable for medical malpractice.

To protect themselves, most health care providers purchase medical malpractice insurance. When an insured provider makes a mistake that leads to a medical malpractice lawsuit, the lawsuit is typically handled by the provider’s insurer. Medical malpractice insurance companies use a slew of defense tactics to try to minimize their liability, one of which is to claim that patients’ losses are attributable to pre-existing conditions.

What Qualifies as a Pre-Existing Condition in a Medical Malpractice Case?

The concept of a pre-existing condition within the context of a medical malpractice case is somewhat complicated because most people who seek medical treatment go to the doctor’s office or hospital with – and to seek treatment for – an illness or injury. Seeking treatment for a disease or injury does not mean that you necessarily have a “pre-existing condition,” and you can file a medical malpractice claim if you were seeking treatment for a condition that you had before the date of your visit.

In the context of a medical malpractice case, a pre-existing condition can mean either: (i) a situation that was not treatable at the time treatment was sought, or (ii) a condition that exacerbates another condition for which treatment is needed.

For example, let’s say a patient goes to the hospital with a concussion. Concussions can have a variety of effects regardless of whether the patient seeks treatment. Suppose a patient experiences these effects after seeking treatment. In that case, the patient most likely will not claim medical malpractice since the impact would have happened regardless of the quality of care the patient received.

Now, let’s say a patient goes to the hospital with a concussion, and the patient has a pre-existing condition that makes him or her more prone to suffering severe complications. Suppose the patient suffers severe complications due to a medical mistake (i.e., failure to diagnose). In that case, the health care provider’s insurance company cannot use the patient’s pre-existing condition as a basis for denying liability.

What are the Implications of a Pre-Existing Condition in a Medical Malpractice Case?

In medical malpractice cases involving pre-existing conditions, the outcome will often be determined by what is known as the “eggshell plaintiff doctrine.” Under this doctrine, a patient’s pre-existing condition is not a bar to financial recovery. Instead, the health care provider and its insurance company must “take the patient as he or she comes.” Suppose a patient suffers from a pre-existing condition, and the consequences of medical malpractice are worse than they would have been otherwise. In that case, the health care provider (or its insurance company) is still fully liable for the financial costs the patient incurs due to the health care provider’s negligence.

How Do You Prove That Medical Malpractice is to Blame?

When dealing with a “pre-existing injury” defense, the key to pursuing a successful medical malpractice claim is causation. To recover financial compensation, a patient (or the patient’s family) must be able to prove that a health care provider’s mistake caused the patient’s losses or the patient’s death.

To illustrate, let’s now consider a scenario in which a patient goes to the hospital complaining of abdominal pain and other general symptoms. Unbeknownst to the patient, he or she is suffering from stage 1 stomach cancer. After conducting a standard panel of tests, the patient’s doctor diagnoses heartburn, recommends an over-the-counter medication, and sends the patient home.

Over time, the patient’s condition worsens; and, when the patient seeks treatment again a year later, his or her cancer has progressed significantly.

The patient files a claim for medical malpractice based on a misdiagnosis. In defense, the doctor’s insurance company argues that the patient already had stage 1 cancer at the first visit. The severity of this “pre-existing condition” means that doctor’s misdiagnosis did not cause the patient’s ensuing medical costs and other losses. Is this a valid defense?

No, it is not. To prove causation – to prove that medical malpractice is to blame for the patient’s current condition – the patient could present evidence showing that a timely diagnosis would have allowed for treatment that would have slowed or stopped cancer’s progression. In other words, if it were not for the misdiagnosis, the patient could have obtained the treatment he or she needed to prevent further complications. In this scenario, the doctor’s misdiagnosis is a causal factor, and the patient should be able to recover just compensation for medical malpractice.

What Should You Do if You Have Concerns about a Possible “Pre-Existing Condition” Defense?

If you believe that you or a loved one may be a victim of medical malpractice, and if you have concerns that your health care provider’s insurance company may try to assert a “pre-existing condition” defense, what should you do? At this point, your next step should be to consult with an attorney. An experienced Connecticut medical malpractice attorney will be able to assess your legal rights, file a claim on your behalf, and work with trusted medical experts to prove that medical malpractice is a causal factor in your case.

Schedule a Free Consultation with a Connecticut Medical Malpractice Attorney Today

Do you have questions about seeking just compensation for medical malpractice in Connecticut? If so, we encourage you to get in touch. One of our experienced Connecticut medical malpractice attorneys will be happy to sit down and speak with you one-on-one. To schedule a free, no-obligation consultation at your convenience, visit us today.