Higher Standard of Proof Required Regarding Any Claim of Medical Negligence in Emergency Room

In Stafford v. Burns, the Plaintiffs/Appellants argued that the superior court committed error by instructing the jury at trial that it could not find the Defendant doctor liable unless Plaintiffs provided “clear and convincing” evidence of medical negligence.  In a unanimous decision filed on January 17, 2017, the Arizona Court of Appeals disagreed with Plaintiffs and affirmed the defense verdict in favor of the doctor.

The Stafford’s son had been admitted to the emergency department of St. Joseph’s Hospital in Phoenix in the early morning hours of February 5, 2012, having ingested an unknown quantity of methadone. He was observed for several hours under Dr. Burns’ care until 1:00 p.m. at which time he was considered stabilized and was discharged.  Approximately thirty hours later, the son was found dead.  The Staffords claimed Dr. Burns had discharged the son too early and that his death from respiratory depression was proximately caused by the premature discharge.  Dr. Burns presented evidence to the effect that it was likely the son had ingested additional drugs in the intervening period following his discharge, and that any possibility of the onset of severe respiratory depression commencing well in excess of thirty hours after the ingestion of a methadone overdose was remote, at best.

Arizona case law requires proof by a preponderance of the evidence that a health care provider has been negligent in order to successfully prosecute a medical malpractice claim for injuries allegedly caused by the provider under most circumstances.  However, under federal law [EMTALA], licensed hospitals are required to provide services to anyone presenting to an emergency room for treatment and must provide “such further medical examination and such treatment as may be required to stabilize the medical condition…”  Because of the burden of these requirements on hospitals and emergency physicians, the Arizona legislature has seen fit to raise the burden of proof to “clear and convincing evidence.”  See, A.R.S. Sec. 12-572(A).  While a preponderance of the evidence is the lowest required standard of proof for the successful prosecution of a claim requiring that the claim need only be “more likely valid than not,” clear and convincing evidence mandates a higher degree of clarity than that which is simply “more likely,” however, does not include the certainty required for proof “beyond a reasonable doubt,” which is the applicable standard in criminal cases.

The Staffords additionally argued that at the time of his discharge, their son’s condition was no longer an “emergency situation” and, therefore, the doctor should not have been entitled to an instruction on the plaintiffs’ enhanced burden of proof.  Again, the Court disagreed noting that EMTALA applies whenever a patient comes to a hospital for “what may be  an emergency medical condition”  and is not limited to what in fact “is” an emergent condition.  The court went on to note that part of the purpose of the Arizona statute is to provide a more attractive environment necessary to address the State’s shortage of emergency room physicians, and therefore it should be interpreted liberally.  As such, any and all treatment provided in an emergency department is to be legally examined under the auspices of the clear and convincing standard.

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