Opinion ID: 2342794
Heading Depth: 1
Heading Rank: 8

Heading: Conduct harmful to a patient

Text: The healing arts board alleged that Dr. Tendai was subject to discipline pursuant to section 334.100.2(5), which allows discipline for [a]ny conduct which is or might be harmful or dangerous to the mental or physical health of a patient or the public .... The commission concluded that Dr. Tendai's conduct was harmful to the health of the patient, not that his conduct might or could have been harmful. That is the conclusion presented for review. To sustain this conclusion, there must be evidence that Dr. Tendai's conduct caused injury to S.G.'s baby. In this case, the record must contain substantial evidence that Dr. Tendai's conduct caused or contributed to cause the baby's death. Missouri follows the but for test of causation in medical negligence cases. Callahan v. Cardinal Glennon Hospital, 863 S.W.2d 852, 862-63 (Mo. banc 1993). Under this test, a physician is found to have caused a harm if the harm would not have occurred but for the physician's negligence. Id. at 861. In the absence of a statutory definition of harmful to the mental or physical health of a patient, the but for standard of causation is applicable to this provision of section 334.100.2(5). The board cannot rely on the mere fact that S.G.'s baby died in utero to support its contentions that Dr. Tendai's conduct caused the death. See Swope v. Printz, 468 S.W.2d 34, 39 (Mo.1971). S.G.'s baby was born with the umbilical cord wrapped tightly around its neck. The testimony from the expert witnesses indicated that IUGR, in and of itself, would not cause the baby to die; it would only cause the baby to be born smaller than normal. Nor was there any testimony that in utero growth retardation would cause an umbilical cord wrap. The board's evidence on causation was equivocal and, thus, insufficient. Dr. Cameron, consulted initially by S.G. for a malpractice lawsuit, testified that he believed the baby's death was preventable if proper monitoring had been done. This is not a statement that Dr. Tendai's conduct was a cause of harm to the baby. If it could be interpreted as causation, it is equally likely to be a statement merely of timingthat is, if the baby had been delivered before fetal demise the death would have been prevented. This preventable theory of causation is too attenuated to impose liability on a doctor for negligence or malpractice, Callahan, 863 S.W.2d at 865, and is likewise insufficient in a discipline case. There is nothing in the testimony of the case to suggest that the fatal cord wrap was anything more than a tragic accident that occurred shortly before the baby was delivered. There is not a single expert statement that, to a reasonable degree of medical certainty, Dr. Tendai's conduct caused harm to the baby. To the contrary, the record as a whole negates a causal link between Dr. Tendai's conduct and the harm to the baby. Dr. Johnson believed the baby's death was caused by strangulation by the umbilical cord and that Dr. Tendai was not negligent. The autopsy supports this position. Dr. Johnson also testified that IUGR would not, in and of itself, have caused fetal death. Similarly, Dr. Griffin testified that the terminal event was strangulation by the umbilical cord. None of the expert witnesses was able to testify with a reasonable degree of medical certainty that IUGRand not strangulation by the cordcaused the death. The board did not prove the suggested monitoring would have prevented strangulation by the umbilical cord. Since the board did not prove causation, the commission's conclusion that Dr. Tendai committed conduct harmful to a patient is not supported by substantial evidence and must be reversed.