BREACH & CAUSATION ANALYSIS WORKSHEET
A structured framework for comparing expected standards of care to actual care delivered and linking deviations to patient harm.
Breach and causation are the core of every healthcare negligence case. This worksheet helps attorneys systematically evaluate whether the care provided met accepted standards, identify deviations, and determine how those deviations contributed to the patient’s injury or death.
Use this tool during case screening, expert preparation, mediation, and deposition strategy.
DEFINE THE STANDARD OF CARE
✔ Identify Applicable Standards
• Regulatory requirements
• Facility policies and procedures
• Professional guidelines (ANA, CMS, Joint Commission, specialty societies)
• Manufacturer instructions (devices, medications)
• Industry norms for similar settings
✔ Clarify Expected Actions
• What should have been assessed
• What should have been monitored
• What interventions were required
• What communication or escalation was expected
DOCUMENT WHAT ACTUALLY OCCURRED
✔ Extract Key Facts from the Record
• Assessments performed
• Vitals documented
• Interventions provided
• Provider notifications
• Medication administration
• Lab/imaging orders
• Reassessments
• Communication with family/caregivers
✔ Identify Gaps
• Missing documentation
• Contradictory entries
• Late entries
• Copy‑and‑paste notes
• No follow‑up after abnormal finding
COMPARE EXPECTED VS. ACTUAL CARE
✔ Side‑by‑Side Comparison
• Expected assessment → Actual assessment
• Expected monitoring → Actual monitoring
• Expected interventions → Actual interventions
• Expected communication → Actual communication
• Expected escalation → Actual escalation
✔ Identify Deviations
• Missed assessments
• Delayed interventions
• Failure to notify the provider
• Failure to escalate
• Medication errors
• Unsafe environment not addressed
IDENTIFY BREACH OF STANDARD OF CARE
✔ Determine Whether a Breach Occurred
• Did the provider fail to act as a reasonably prudent clinician would?
• Did the facility fail to follow its own policies?
• Did staff ignore red‑flag symptoms?
• Were required interventions delayed or omitted?
Common Breach Indicators
• No reassessment after interventions
• No provider notification
• Missed or late medications
• Delayed response to deterioration
• No documentation of communication
• Ignoring abnormal labs or vitals
CAUSATION ANALYSIS
✔ Link Breach to Harm
• What harm occurred?
• Was the harm foreseeable?
• Would timely intervention have prevented deterioration?
• Did delays worsen the patient’s condition?
• Did the breach contribute to death or injury?
✔ Build the Causation Narrative
• “If X had occurred, Y would likely have been prevented.”
• “The delay in Z allowed the condition to worsen.”
• “Failure to escalate resulted in preventable deterioration.”
TIMELINE INTEGRATION
✔ Connect Breach to Timeline
• When did the breach occur?
• How long was the delay?
• What happened during the delay?
• What was the patient’s condition before and after?
This strengthens both breach and causation arguments.
GLOBAL RED FLAGS
• Missing documentation
• Contradictory entries
• No reassessment
• No provider notification
• Delayed escalation
• Medication discrepancies
• Ignored abnormal labs or vitals
• Unsafe environment not addressed
• No follow‑up after new orders
These are the strongest indicators of breach and causation across all healthcare settings.