1. The issue of negligence is that people have a duty of reasonable care to each other to avoid mutual harm. A case of negligence arises when a person is injured because another person failed to exercise reasonable care. In medical matters, injury includes care provided by a physician or medical facility. Four elements must be proven. The first element is “duty. Liability is usually considered to be established through the physician-patient relationship and is the need to provide care, although reasonable or standard care is all that is required for liability. The second element is the “breaking of the loop” establishing liability. Breakage often occurs when the responsible individual fails to provide reasonable care or act according to a standard of care. The third element is “causation,” which is the causal connection between the breach of duty and the injury suffered by the plaintiff. Sometimes a patient suffers an injury and there is one or more breaches of the standard of care. Unless the breach caused the injury, the case lacks causation. Causation can be proven by two legal tests, the “if-not rule” and the “substantial factor rule”. If the plaintiff can prove by a preponderance of the evidence that “but for” the defendant’s breach of duty, the injury would not have occurred, then he or she is likely to succeed. Alternatively, if the plaintiff successfully proves that the defendant’s breach of duty was a substantial factor in causing the plaintiff’s injury, even though other factors may have been present, including those mentioned in the plaintiff’s complaint or non-complaint, then the plaintiff is likely to prevail. The fourth element is “injury,” which is the economic value placed on the plaintiff’s injury. Although the plaintiff’s damages may be physical, financial or emotional, the injury will be calculated to compensate the plaintiff and restore his or her integrity. Calculated injuries include medical expenses (current and future), loss of income and loss of productivity attached to the injury, pain and suffering suffered by the patient, and loss of spousal rights, all of which will be calculated on economic terms. Punitive damages are intended to penalize the defendant for seeking gross negligence, i.e., willful and unethical neglect of the plaintiff’s health. 2. Medical Standards and Expert Testimony The duty to provide reasonable medical care is the basic law of torts, expressed in terms of acting in accordance with the methods of a person who would act reasonably under the same or similar circumstances. In a medical negligence action, reasonable medical treatment requires a slightly different perspective for the purpose of establishing a standard of care. The standard of care is the way physicians of comparable training and experience would have acted in the same or similar circumstances. In addition to published information that can be used to establish a standard of care, an expert witness is required to testify to both parties that the defendant physician has performed or should have performed a reasonable act. Expert testimony is designed to establish the existence of a doctor-patient relationship related to medical liability and to establish a breach of such liability and a violation of the standard of care. Expert testimony is also intended to establish that a breach of factual duty was a substantial factor in causing the plaintiff’s injury. Interestingly, there is always the possibility that the expert’s opinion will fully support the plaintiff and the defendant.