When medical malpractice cases come to trial, the tendency is for claims to have evolved or even changed altogether. The cases have reached a point at which there is a more careful synthesis of the facts with the conclusions they support. Substantial prejudice may result from the new focus brought to bear upon complex treatment, with a changed perspective on the legal obligations of health care provider to patient.

Unless defense counsel pays careful attention to the shifts caused by this evolution, the process may create a changed paradigm for the evaluation of the quality of care rendered. The Bill of Particulars serves as a valuable guide to avoid resultant prejudice, and the courts are willing to protect the defendant from the belated imposition of new claims and new theories of recovery provided that the request is timely and properly articulated.

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