The preparation of the defense of a medical malpractice claim necessarily involves expert review, but there is more here than meets the eye. The focus at trial will be whether there was a violation of the prevailing standard of care by the defendant and whether that caused injury to the patient. All too often the primary focus is placed upon the defense of the liability issues while the defense of proximate cause receives less attention. The defendant surgeon or gynecologist may be of assistance to defense counsel on standard of care and consent issues, but causation defenses may involve the interpretation of radiology and pathology studies or other subjects which are not within the knowledge of the defendant or the expert witnesses in the defendant’s specialty. Without full exploration of the causation issues, the defense is ill prepared for trial.

Expert testimony is required to establish the standard of care, a departure from that standard, and that the departure was a proximate cause of the damages claimed. Koehler v. Schwartz, 48 N.Y.2d 807 (1979). Finding that the patient’s disease process had reached an incurable stage before the defendant’s treatment, and that there was no expert evidence to support the claim that malpractice caused injury, the Appellate Division in Lubbe v. Hilgert, 135 AD 227 (1st Dept. 1909) vacated a verdict in favor of the plaintiff and dismissed his complaint. Likewise, in Robbins v. Nathan, 189 A.D. 827 (2d Dept. 1919), the court found that causation cannot be decided upon the testimony of lay witnesses or by jurors based on their own experience, vacating the verdict in favor of the plaintiff and dismissing the complaint. In preparing a case for trial, ignoring the effects of such a solidly established point of law would be a grave disservice to the defendant.