Friday, March 23, 2012

Zuchowicz V. US case brief

Zuchowicz v. United States
140 F.3d 381, 1998 U.S. App. 5366.

FACTS
-Plaintiff filed prescription for the drug, Danocrine.
-Prescription erroneously instructed P to take 1600 milligrams of Danocrine per day (twice the maximum recommended dosage).
-Plaintiff took the 1600 milligram dose each day for a month and experienced abnormal weight gain, bloating, hot flashes, night sweats, a racing heart, chest pains, dizziness, headaches, acne, and fatigue. -P was told to stop taking the drug.
-P was diagnosed with primary pulmonary hypertension (PPH). She was expected to live 2.5 more years. She was on the waiting list for a heart lung transplant when she got pregnant.
-Because P was pregnant, she was ineligible for a heart lung transplant.
-P gave birth to her son and died a month later.
-P claims that she developed PPH due to the overdose of Danocrine, brought suit against D under the Federal Tort Claims Act.

-Expert testimony revealed that Danocrine was responsible for Plaintiff’s PPH.
-The doctor did not rule out all other possible causes of PPH, but he did exclude all other causes of secondary pulmonary hypertension.
-Expert testimony also ruled out all previously known drug related causes of PPH.
-The progression and timing of Plaintiff’s disease in relation to her overdose supported a finding of drug-induced PPH.

PROCEDURAL HISTORY
-Judgment for Plaintiff. Defendant appealed.

ISSUE
-Did P present sufficient evidence that the overdose of Danocrine was the cause of her illness?

HOLDING
-Yes.  Expert testimony was presented and supported a finding of drug-induced PPH to a reasonable medical certainty. There was not a long latency period between the onset of symptoms and the patient’s exposure to the drug.

RULES
-In order to prove causation, it is necessary that the finder of fact be able to conclude, more probable than not, that the overdose was the cause of Plaintiff’s illness and his/her ultimate death.
-The mere fact that the exposure to Danocrine was likely responsible for the disease is not enough.
-If (a) a negligent act was deemed wrong because the act increase the chances that a particular type of accident would occur; and (b) a mishap of that very sort did happen, this is enough to support a finding by a tier of fact that the negligent behavior caused the harm. When such a strong casual connection exists, the burden shifts to D to show that the wrongful conduct was not a substantial cause.

NOTES (law and economics)
• Calabresi – concept of causal linkage – D’s action was the most likely cause of P’s injury
• docs prescribed way too much medication to P
• no statistical info – we don’t know if the overdose caused PPH; (PPH) is very rare
• P has expert testimony
• Dr. Matthay and Dr. Tackett – they both assert that there is reasonable medical certainty that the overdose caused the PPH
• Not absolute certainty, but reasonable certainty
• Calabresi has inserted his idea of causal linkage into the law
• Calabresi brings Cardozo and Traynor into the fray  – claims that these judges/commentators assert the concept of causal linkage as well
• burden shifting proposition – it is up to the negligent party to prove that the negligent conduct had not been a substantial factor in the injury
• court loosens ‘but for’ analysis and uses statistical analysis to allow plaintiff to succeed on claim
• holding for plaintiff.



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