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Law School Case Brief

Callahan v. Cardinal Glennon Hosp. - 863 S.W.2d 852 (Mo. 1993)


The "but for" causation test provides that the defendant's conduct is a cause of the event if the event would not have occurred "but for" that conduct. Put simply, "but for" causation tests for causation in fact. Mere logic requires causation in fact.


Several months after he was born, Daniel Callahan received a live polio vaccine. Until the end of November, Daniel remained basically in good health. On November 30, 1978, Daniel's mother noticed a red area between Daniel's anus and *** – this developed into a "boil" the size of a nickel with a white center. After suffering from a persistent fever, Daniel’s parents brought him to Cardinal Glennon Hospital where he was assessed and diagnosed to have a perirectal abscess. The doctor prescribed Oxycillin, an effective antibiotic for gram positive but not gram negative bacteria – this was prescribed without taking a sample culture from the “abscess” in order to determine whether it contained gram positive or gram negative bacteria. Despite the antibiotic, Daniel’s condition continued to worsen, even experiencing paralysis of his arms and legs. He was brought back to the hospital where a physician incised and drained the abscess. Cultures of the abscess revealed four types of gram negative bacteria. At this time, Daniel received a different antibiotic that, unlike Oxycillin, was effective against gram negative organisms. Daniel's condition did not improve, and his legs and left arm remain paralyzed. After 18 days at Cardinal Glennon Hospital, Daniel was released. Daniel’s parents filed a medical malpractice suit against those involved. Testifying on Daniel’s behalf were two expert witnesses who concluded that the cause of Daniel’s paralysis was the failure of the hospital to treat the abscess properly. The jury returned a verdict in favor of Daniel and awarded him with $16 million in compensatory damages. The defendants appealed, asserting that plaintiff failed to present sufficient evidence of causation.


Did the plaintiff fail to present sufficient evidence of causation to establish medical malpractice on the part of the defendants?




The Court affirmed the trial court's judgment in favor of Daniel. According to the Court, the testimony of the two expert witness was sufficient to establish that the paralysis would not have developed but for defendants’ negligence in failing to treat the abscess. The Court posited that the notion that an injury would likely result to a patient who received negligent medical care met traditional causation requirements. According to the Court, the patient was not required to prove that it was foreseeable to the doctors that their negligence in treating the abscess would result in the development of paralysis because any time a physician or nurse acted negligently in the treatment of a patient, it was foreseeable an injury to the patient might result.

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