Legal Definitions - loss-of-chance doctrine

The loss-of-chance doctrine is a legal principle recognized in some jurisdictions that allows a patient to pursue a claim against a healthcare provider for medical malpractice, even if the provider's negligence did not directly cause the patient's ultimate poor health outcome. Instead, this doctrine applies when a healthcare provider's negligent actions or inactions significantly reduced or eliminated the patient's chance of a better recovery, survival, or avoiding a more severe progression of a pre-existing condition. It acknowledges that a patient has suffered a compensable injury when their probability of a positive outcome was diminished due to substandard medical care.

Here are some examples illustrating the loss-of-chance doctrine:

• Example 1: Delayed Diagnosis of Cancer

  A patient visits their primary care physician complaining of persistent fatigue, unexplained weight loss, and a nagging cough. The doctor dismisses these symptoms as a common cold and stress, without ordering standard diagnostic tests like a chest X-ray or blood work. Six months later, the patient is diagnosed with an aggressive form of lung cancer that has metastasized to other organs.

  How it illustrates the doctrine: While the doctor did not *cause* the cancer, their failure to investigate the symptoms promptly meant the cancer progressed untreated for six months. Under the loss-of-chance doctrine, the patient could argue that the doctor's negligence significantly reduced their chance of successful treatment and long-term survival, as early detection would have offered a much higher probability of remission or cure.

• Example 2: Improper Management of a Heart Condition

  A patient with a known history of heart disease is admitted to the emergency room experiencing chest pain. The attending physician, misinterpreting the electrocardiogram (ECG) results, delays administering clot-busting medication and fails to consult a cardiologist for several critical hours. The patient subsequently suffers a major heart attack, resulting in significant and permanent heart damage.

  How it illustrates the doctrine: The patient already had a serious pre-existing condition (heart disease and chest pain indicating a potential cardiac event). The medical team's negligence (misinterpretation of tests and delayed treatment) did not *cause* the underlying heart condition, but it arguably reduced the patient's chance of preventing the major heart attack or mitigating its severity, thereby leading to a worse outcome than might have been possible with timely, appropriate care.

• Example 3: Failure to Refer for Specialized Care

  A pregnant woman experiences unusual bleeding and severe abdominal pain during her second trimester. Her obstetrician, despite these concerning symptoms, assures her it's likely benign and delays referring her to a high-risk pregnancy specialist for further evaluation or ordering an immediate ultrasound. Days later, she suffers a premature labor and loses the baby.

  How it illustrates the doctrine: The obstetrician's failure to promptly refer or order appropriate diagnostic tests meant that any potential interventions that might have saved the pregnancy were not explored in a timely manner. While the premature labor and loss might have occurred regardless, the loss-of-chance doctrine would allow the woman to claim that the doctor's negligence deprived her of the *chance* to potentially prevent the loss or understand its cause, by delaying access to specialized care that could have offered a better outcome.