Background
Tanya Smith was initially diagnosed and treated for metastatic breast cancer. She was actually suffering from ALK-positive B-cell lymphoma. Her estate alleged that oncologist Dr. Annie Kannarkatt failed to question the diagnosis despite later clinical and radiological findings that were inconsistent with it. During the delay, Smith received inappropriate chemotherapy, her lymphoma spread, and she ultimately died.
Medical-malpractice plaintiffs ordinarily must present expert testimony establishing breach and proximate causation to a reasonable degree of medical certainty. Pennsylvania’s increased-risk-of-harm doctrine addresses cases in which negligent treatment increased a patient’s risk even though medicine cannot establish that proper treatment certainly would have prevented the ultimate outcome. The trial court entered a compulsory nonsuit, concluding that the estate’s causation evidence was insufficient.
The Superior Court vacated and remanded. The Supreme Court then considered whether the experts supplied a prima facie case under Hamil v. Bashline and its progeny.
The Court’s Holding
Justice Brobson wrote for a unanimous Court in affirming the Superior Court. The estate’s oncology expert testified that Dr. Kannarkatt breached the standard of care by failing to revisit the original pathology diagnosis when later testing produced inconsistent findings. A second expert testified, to a reasonable degree of medical certainty, that the delay deprived Smith of a substantially better opportunity for a longer life.
That testimony was enough to reach a jury. The expert explained that earlier correct treatment improves the opportunity for remission or cure, while the delay allowed the cancer to spread, made it harder to treat, and weakened Smith through inappropriate chemotherapy. The estate did not have to prove at the prima facie stage that timely diagnosis guaranteed survival.
The Court distinguished precedent involving a patient who recovered fully and expert testimony that did not link the alleged breach to increased harm. Here, the patient always had lymphoma, the alleged negligence delayed appropriate treatment, and the disease progressed to death. A jury must decide whether the increased risk was a substantial factor in producing the harm.
Key Takeaways
- Pennsylvania’s increased-risk doctrine applies when negligence reduces a patient’s chance of a better outcome.
- Expert testimony need not establish that proper treatment certainly would have prevented death.
- The plaintiff must still connect the breach, increased risk, and ultimate harm through competent medical testimony.
- Once a prima facie increased-risk case is shown, substantial-factor causation belongs to the jury.
Why It Matters
Smith is significant for Pennsylvania medical-malpractice litigation involving cancer, delayed diagnosis, and loss of a treatment opportunity. It prevents uncertainty inherent in medicine from becoming automatic immunity where expert evidence shows that delay materially worsened the patient’s prospects.
Plaintiff lawyers should develop a timeline connecting each missed diagnostic signal to disease progression and treatment consequences. Defense lawyers should test whether the expert actually identifies an increased risk to the required degree of certainty, rather than merely describing a possibility. The opinion preserves that evidentiary gate while confirming that the final causal judgment is for jurors.
The increased-risk framework changes the order of proof but does not dispense with causation. First, qualified testimony must permit a finding that the defendant’s negligence increased the risk of the type of harm that occurred. If that threshold is met, the jury determines whether the increased risk was a substantial factor in producing the injury. Defense experts remain free to dispute the breach, the biological effect of delay, treatment options, prognosis, and the causal significance of other providers’ conduct.
For delayed-diagnosis cases, the medical record should be organized around decision points: what information became available, which differential diagnoses it suggested, what additional testing was indicated, and how the patient’s therapeutic options changed during the delay. Experts should explain prognosis in clinically meaningful terms rather than offer only generalized statements that earlier care is better. Smith found the evidence sufficient because the opinions connected inconsistent findings, delayed lymphoma treatment, disease progression, harmful chemotherapy, and a lost opportunity for longer survival.