Medical Malpractice Causation Defense: Connection Between Negligence and Harm "Too Attenuated"
Tuesday, August 5, 2008
Contributed by: Mike H. Loftin
In Providence Health Center v. Dowell, -- S.W.3d ---, 2008 WL 2154093 (Tex. 2008), a sharply divided court grappled with the issue of proximate cause in the context of death by suicide. Twenty-one-year-old Lance Dowell was brought to the emergency room of Providence Health Center by the police after he attempted suicide by slitting his wrist severely enough to require stitches. During the ride to the emergency room Lance repeatedly told the police officers that he intended to try again to kill himself. Several years earlier Lance had been hospitalized following an attempt to take his own life, and he had a family history of severe depression.
The hospital discharged Lance within three hours after a brief psychological assessment by a nurse and no psychiatric treatment; and his discharge instructions were to stay with his parents and to return for a follow-up exam in three days. Lance committed suicide by hanging thirty-three hours later. A jury found that the hospital was negligent for failing to comprehensively assess Lance's suicide risk, and that this negligence was a proximate cause of his death. On appeal, the hospital did not challenge the negligence finding by the jury, but argued that, as a matter of law, the hospital's negligence was not a proximate cause of Lance's suicide.
The Court, in an opinion by Justice Hecht, held that the hospital's negligence was too attenuated from Lance's suicide to have been a substantial factor in bringing it about. Justice Hecht pointed out that Lance might not have consented to treatment if it had been recommended and that he could not have been forced to accept treatment. He then noted that hospitalization might not have prevented Lance from taking his own life. Justice Hecht states that the decision to discharge Lance was simply too remote in terms of time and circumstances to have been a proximate cause of the suicide. Justice Hecht points out that after Lance was discharged he spent time being closely observed by members of his immediate and extended family. His family members saw no cause for alarm.
Justice Wainwright, concurring in part and dissenting in part, finds that there was sufficient evidence to support the jury's finding that the hospital's negligence was a proximate cause of Lance's suicide. However, Justice Wainwright would have reversed and remanded for a new trial because, in his opinion, the trial court erred in refusing to submit Lance's conduct to the jury so his proportionate responsibility for his own death could be determined. He points to the evidence that Lance failed to follow the hospital's discharge instructions, which directed him to stay with his parents and take the medication prescribed for him.
Justice O'Neill, joined by Chief Justice Jefferson and Justice Medina, dissented. The dissenting justices would have upheld the jury's finding that the hospital's negligence was a proximate cause of Lance's suicide. Justice O'Neil points to evidence from plaintiffs' expert that an adequate suicide risk assessment would have resulted in hospitalization and treatment by a psychiatrist. As to the contention that Lance would not have consented to hospitalization and treatment, the dissent says that the Court has never required proof that the patient would have followed appropriate medical advice had it been given. As to Justice Wainwright's position that Lance's comparative responsibility for his own death should have been submitted to the jury, the dissent finds no basis in precedent or logic for imposing a duty to comply with treatment plans on patients who are substantially impaired by mental illness.
In summary, five justices looked at the record and determined that the defendant's negligence was too attenuated from the suicide to have been a factor in bringing it about; whereas four justices looked at the same record and determined that there was ample evidence to support the jury's finding that the hospital's negligence was a proximate cause of the suicide.
This column is published for informational purposes only. It should not be construed as legal advice and is not intended to create an attorney client relationship. The views expressed are those of the author and do not necessarily reflect the views of the author's law firm or its individual partners.
