Which types of causation must be established in medical negligence claims?

• A. Actual causation and proximate causation.
• B. Causation is not needed if there is a breach.
• C. Causation determined solely by res ipsa loquitur.
• D. Proximate causation only, not actual.

Answer: (A)

In medical negligence, you must connect the clinician’s breach to the patient’s injury through two causal links. First is actual causation: the harm would not have occurred but for the breach. This is the factual chain—without it, the injury isn’t shown to be a direct result of what the provider did or failed to do. Second is proximate (legal) causation: the injury must be a foreseeable consequence of the breach and lie within the range of harms that society is prepared to compensate for. Even if the breach caused the injury in fact, it won’t be enough if the link to the harm is too remote or not legally connected.

Res ipsa loquitur can help when direct proof is missing by allowing an inference of breach, but it does not automatically establish both layers of causation by itself. It may shift some burden to the defendant to show the injury was not caused by the breach.

Therefore, both actual causation and proximate causation must be established in medical negligence claims.