Speculation Does Not Amount to Causation

Speculation Does Not Amount to Causation

In the world of medical malpractice litigation, the case of Jimmy D. Puckett v. United States of America sheds light on the connections between patient care, medical expert testimony, and the burden of proof in negligence claims.


Case Overview

This case arises from the plaintiff’s treatment at the Southern Arizona Veterans’ Administration Health Care Center. Plaintiff visited a doctor there for a host of issues including allergic rhinitis, hyperlipidemia, chronic obstructive pulmonary disease, and degenerative joint disorder on five occasions. Unfortunately, plaintiff suffered a heart attack two days after his last visit with the doctor, and the EKGs taken the day of his heart attack gave normal results.

Plaintiff’s lawsuit against alleged medical negligence on the part of the treating doctor, asserting her failure to recognize his symptoms and take appropriate action contributed to his heart attack and subsequent injuries. Central to the legal dispute was the question of causation—whether the treating doctor’s actions, or lack thereof, directly led to plaintiff’s harm.


Defendant’s Motion for Summary Judgment

In the legal proceedings, both parties presented arguments and expert testimony to support their respective positions when the defense filed a motion for summary judgment. Plaintiff argued the doctor’s failure to adhere to the standard of care for a reasonable healthcare provider played a significant role in causing his injuries. However, plaintiff did not have solid expert opinion to support that argument. Plaintiff’s expert used speculative language when describing what could have happened if the subject doctor had taken different actions. The plaintiff’s expert opined, “I am certain that this outcome could have been avoided with the right diagnostic workup and the combination of invasive interventions, such as coronary angioplasty or surgery, and medications such as high-intensity statins and antiplatelet drugs.”[i]

The United States of America contended plaintiff failed to establish a clear link between the doctor’s actions and his heart attack, thereby undermining his claim of medical negligence, but the plaintiff argued the doctor should have recognized he was at risk for a heart attack and ordered an EKG. The court reasoned that an EKG probably would not have made a difference since plaintiff’s EKGs taken the day of his heart attack were normal.

The court granted summary judgment. Their rationale ultimately turned on the issue of causation, a crucial element in medical malpractice cases. Under Arizona law, plaintiffs must demonstrate a causal connection between the alleged negligence and the resulting harm, typically through expert medical testimony. In other words, “to prove causation, experts are utilized to ‘connect the dots’ from a claimed violation of the standard of care to the cause of the injury.”[ii]



Retaining a great expert who can be clear, concise, and effective can be worth the extra expense. When your attorney vets experts to work on a case, remember your experts must be as certain as possible in the language they use. They will have to testify to all their opinions within a certain degree of medical probability to carry the burden of proving issues related to both the standard of care and causation.



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[i] Puckett v. United States, CV-21-014553-PHX-SMB

[ii] Id.