Negligence Leading to Suicide : Pursuing a Wrongful Death Claim

Below is an interesting Missouri Supreme Court ruling regarding the ability to recover for wrongful death when a defendant’s negligence directly causes a person to commit suicide. I cut out much of the procedural jargon so that you can read the heart of the opinion.  Please note that for a full legal analysis, it is necessary to read the full opinion, which can be found here.

KIVLAND v. COLUMBIA ORTHOPAEDIC GROUP LLP

No. SC 90708 – January 25, 2011

Introduction

In January 2005, Dr. Robert Gaines performed spine surgery on Gerald Kivland. Following the procedure, Kivland allegedly became paralyzed from the waist down and experienced continuous, extreme pain. In July 2005, Kivland filed a medical negligence lawsuit against Dr. Gaines and his employer, Columbia Orthopaedic Group LLP (collectively referred to as “Dr. Gaines”). He sought damages for injury, disability, and suffering. His wife, Jana Kivland, filed a separate claim for loss of consortium.

Since this case is being reviewed before trial, it is important to note that the facts have not yet been proven and remain allegations.

Eight months after filing the lawsuit, Gerald Kivland died by suicide.

Claims After Kivland’s Death

Following his death, the Kivlands amended their lawsuit to include a wrongful death claim. This amendment effectively created two distinct claims:

1. Wrongful Death Claim
   The wrongful death claim alleged that Dr. Gaines’ negligence directly caused Kivland’s death. If this claim is viable:
   • Kivland’s original claims for injury, disability, and suffering merge into the wrongful death claim.
   • Jana Kivland’s claim for loss of consortium also merges into this claim.
   • The wrongful death claim is pursued by Jana Kivland and her daughter, Kristin Bold, as beneficiaries under Missouri’s wrongful death statute (Section 537.080, RSMo 2000).
2. Survivor Claim
   The survivor claim argued that Dr. Gaines’ negligence caused Kivland’s injury, disability, and pain, but not his death. This claim, which existed at the time of Kivland’s death, passed to his estate.
   • Jana Kivland, as the estate’s representative, pursued recovery under Section 537.020, RSMo 2000.
   • Jana also retained her individual claim for loss of consortium incurred before her husband’s death.

Court Decisions and Professional Testimony

Dr. Gaines made two key motions in response to the amended claims:

1. Motion to Strike Professional Witness
   Dr. Gaines sought to exclude the Kivlands’ Professional witness, whose testimony linked Kivland’s suicide to extreme post-surgical pain caused by negligence. The circuit court granted this motion, effectively removing the professional opinion from consideration.
2. Motion for Partial Summary Judgment
   Dr. Gaines argued that suicide constituted an independent, intervening cause of death, unrelated to the alleged negligence. The circuit court agreed and granted partial summary judgment on the wrongful death claim.

This judgment was designated as final for appeal under Rule 74.01(b), disposing of the wrongful death claim. However, the survivor claim on behalf of Gerald Kivland’s estate remains pending in the circuit court.

Key Legal Question

The central issue in this appeal is whether Gerald Kivland’s suicide was an intervening cause of death that legally disconnects Dr. Gaines’ alleged negligence from the wrongful death claim. If the suicide is deemed an intervening cause, the wrongful death claim cannot proceed, and professional testimony about post-surgical pain is irrelevant.

Lost Chance of Survival

The claim for “lost chance of survival” does not survive Gerald Kivland’s death. The court correctly dismissed this claim, either through a motion to dismiss for failure to state a claim or a motion for summary judgment.

Wrongful Death Claim

The circuit court granted summary judgment in favor of Dr. Gaines on the wrongful death claim, ruling that the Kivlands failed to demonstrate a genuine issue of material fact regarding causation. Specifically, the court evaluated whether Dr. Gaines’ alleged negligence directly caused Gerald Kivland’s suicide.

Causation in Wrongful Death Claims

Under Missouri law, a plaintiff in a wrongful death case must show that the defendant’s negligence “directly caused” or “directly contributed to cause” the decedent’s death. This standard is established in Callahan v. Cardinal Glennon Hospital, 863 S.W.2d 852 (Mo. banc 1993).

When suicide is involved, Missouri courts have historically treated it as a potential intervening act that may break the causal chain unless specific conditions are met.

Missouri’s Standard on Suicide and Causation

The precedent set in Wallace v. Bounds, 369 S.W.2d 138 (Mo. 1963), provides the framework for determining causation in cases where suicide follows a defendant’s alleged negligence. According to Wallace:

1. Voluntary Suicide: If a suicide is deemed voluntary (the result of mental anguish without insanity), it is considered an independent and intervening act, severing liability.
2. Involuntary Suicide: A defendant may be held liable if the negligence caused the decedent to become “insane and bereft of reason,” resulting in suicide under an irresistible impulse.

Subsequent cases have further clarified these principles:

• Insanity and Irresistible Impulse: Liability can arise if the decedent was unable to understand the nature or consequences of their actions or was compelled by an insane impulse that overrode their ability to reason.
• Diagnosis of Mental Illness: Dr. Gaines argued that a diagnosed mental disorder or illness is required to prove “insanity” under this standard. However, no Missouri case explicitly mandates such a diagnosis.

Application in Kivland

The Kivlands relied on professional testimony from Dr. Jarvis to establish that Gerald Kivland’s suicide resulted from the unbearable post-surgical pain caused by Dr. Gaines’ alleged negligence. Dr. Jarvis’ testimony sought to show that the pain caused Kivland to act under an irresistible impulse.

However, the court struck Dr. Jarvis’ testimony, rendering it inadmissible. Without this testimony, the Kivlands could not provide sufficient evidence to meet the causation requirement for wrongful death. The court concluded that the suicide constituted an independent intervening act, negating the connection between Dr. Gaines’ alleged negligence and Kivland’s death.

Key Takeaway

Missouri law permits recovery for wrongful death resulting from suicide only under specific circumstances. The plaintiff must prove that the decedent:

1. Became “insane and bereft of reason” due to the defendant’s negligence.
2. Committed suicide as an involuntary act resulting from an irresistible impulse caused by this insanity.

Legal Precedent and Causation in Wrongful Death Cases

In this case, the court dismissed the wrongful death claim due to insufficient professional testimony and a lack of clear evidence proving that Kivland’s suicide resulted from an involuntary act caused by insanity. Without these elements, establishing liability became impossible.

The Evolving Legal Perspective

Courts have debated whether suicide can be a direct consequence of another party’s negligence. A growing trend shifts the focus from the victim’s mental state to the causal connection between the injury and the suicide. In Halko v. New Jersey Transit Rail Operations, Inc., the court emphasized causation over mental state, citing Tate v. Canonica, Zygmaniak v. Kawasaki Motors Corp. U.S.A., and Fuller v. Preis.

The New York Court of Appeals in Fuller suggested that negligence leading to suicide might warrant recovery, even without proof of a specific mental disorder or irresistible impulse. The court reasoned that if a strong causal link exists between the original injury and the suicide, compensation should still be considered.

Psychiatry’s View on Suicide and Trauma

Modern psychiatry recognizes that suicide can sometimes be a foreseeable result of traumatic injuries. Studies, including those cited by Allen C. Schlinsog Jr., indicate a correlation between trauma and suicide risk. A Journal of Trauma study found that suicide rates are significantly higher among trauma patients, particularly older white males, individuals with alcohol-related injuries, and those suffering from long-term disabilities.

Missouri’s Causation Standard

Missouri law requires wrongful death cases to prove that the decedent’s death was a direct result of the defendant’s negligence. Dr. Gaines urged the court to create an exception for suicides, but such a departure from the established causation standard did not hold up under legal scrutiny.

Proving Causation in Wrongful Death Cases Involving Suicide

When a wrongful death case involves suicide, must the plaintiff prove that the decedent was “insane” and acting under an “irresistible impulse” at the time of death? Courts have struggled with defining this standard, leading to varying interpretations.

The Challenges of the Irresistible Impulse Test

Courts have interpreted “irresistible impulse” differently. Some rulings suggest that it does not always mean a sudden, uncontrollable action. In Fuller v. Preis, the court determined that a jury could find an irresistible impulse even when the decedent planned the suicide, wrote notes, changed a will, and acquired a gun. Similarly, in Orcutt v. Spokane County, the court found evidence of an irresistible impulse despite the decedent’s multiple previous attempts at suicide over several months.

Other courts have taken a stricter approach. Many rulings state that if the decedent carefully planned the suicide and understood their actions, an irresistible impulse did not exist—even when the suicide resulted from injuries sustained in the incident. Cases such as Dry Storage Corp. v. Piscopo and Daniels v. New York, N.H. & H.R. Co. have reinforced this view.

Missouri’s Standard for Causation in Wrongful Death

Given the inconsistent interpretations of the irresistible impulse test, Missouri law focuses on whether the defendant’s negligence directly caused the decedent’s death. Before a jury can determine causation, the plaintiff must present evidence establishing that the defendant’s actions were the proximate cause of the suicide.

Under Alcorn v. Union Pac. R.R. Co., if a plaintiff fails to provide sufficient evidence, the case cannot proceed. Missouri law defines proximate cause as the “natural and probable consequence” of the defendant’s conduct, as clarified in Callahan. A plaintiff can meet this burden by showing that the suicide was a direct result of the injuries caused by the defendant. In many cases, professional witness testimony is necessary to establish this link. Without such evidence, the suicide may be considered an intervening cause, preventing the claim from reaching the jury.

When Can a Jury Decide Causation?

If a plaintiff presents evidence showing that the injury led to the suicide, the jury decides whether the defendant’s negligence directly caused the death. The defendant can counter this argument by offering professional testimony or other evidence to challenge the causation claim.

If the jury concludes that the suicide did not result from the original injury, they will not hold the defendant liable. However, if they find that the defendant’s negligence directly caused the death, they may impose liability.

Missouri Courts Uphold Existing Causation Standards

This ruling does not change Missouri’s causation standard for wrongful death cases. Instead, it reaffirms that when suicide occurs, the plaintiff must establish a direct causal link between the defendant’s negligent actions and the decedent’s death.

No modifications to Missouri Approved Instructions (MAI) are necessary. The current instructions remain sufficient for presenting causation issues to the jury. MAI 20.01 and 21.01 already require proof that the decedent died as a direct result of the defendant’s negligence.

The Admissibility of Dr. Jarvis’ Professional Testimony

Since Gerald Kivland is no longer able to explain his actions, professional testimony plays a crucial role in establishing a causal link between his injuries and death. The Kivlands’ expert, Dr. Jarvis, testified that Kivland’s extreme pain from surgery led to his suicide and that his decision was not made rationally, making it involuntary. If the jury accepts this testimony, it could conclude that Dr. Gaines’ negligence directly caused Kivland’s death. The key legal question is whether Dr. Jarvis’ testimony should be admissible.

Missouri’s Standards for Professional Testimony

Missouri law, under section 490.065, outlines the criteria for admitting professional testimony in civil cases. The court must determine whether:

1. The professional is qualified based on knowledge, training, education, or experience.
2. The testimony will assist the jury in understanding the case.
3. The professional’s conclusions rely on facts or data commonly used in the field.
4. The data itself is reasonably reliable.

If an professional meets these requirements, the court must admit the testimony. If not, it must be excluded. The trial judge has the authority to independently assess whether the expert’s data is reliable (McDonagh, 123 S.W.3d at 156).

Reviewing a Trial Court’s Decision

Appellate courts typically review a circuit court’s decision on professional testimony under an abuse of discretion standard (Klotz v. St. Anthony’s Medical Center, 311 S.W.3d 752, 760). However, when a court interprets a statute, the review becomes de novo, meaning the appellate court evaluates the decision independently (In re Care and Treatment of Coffman, 225 S.W.3d 439, 442).

Weighing Professional Testimony

The court ensures that the professional meets the statutory requirements, but it does not determine how credible the expert’s testimony is. That responsibility falls to the jury. Jurors evaluate the expert’s conclusions and decide how much weight to give them (Alcorn, 50 S.W.3d at 246). Even if the opposing party questions the professional’s methods or accuracy, those concerns affect the strength of the testimony rather than its admissibility (Elliot v. State, 215 S.W.3d 88, 95).

For the jury to consider Dr. Jarvis’ testimony, the court must first determine whether he meets the legal criteria under section 490.065. If the trial court finds that his testimony is based on reliable data and will assist the jury, it must allow it. However, if it fails to meet the standard, the court has the authority to exclude it. Ultimately, the jury will decide whether to accept Dr. Jarvis’ conclusions and how much weight to give them in determining liability in Kivland’s case.

Summary Judgment on the Wrongful Death Claim

The circuit court ruled that Dr. Jarvis’ opinions—”(1) Kivland took his life due to unbearable pain, and (2) his suicide was not a rational choice and, therefore, was involuntary”—were personal views rather than professional assessments. The court reasoned that Dr. Jarvis lacked a psychiatric diagnosis to explain Kivland’s actions on the day of his death. It concluded that he did not provide testimony establishing that the defendants’ alleged negligence caused Kivland to become insane or act on an uncontrollable impulse.

Additionally, the court determined that although Dr. Jarvis’ affidavit and deposition testimony claimed to be within reasonable medical certainty, he lacked a factual or scientific basis for his conclusions. The court emphasized that all presented evidence indicated Kivland was not experiencing insanity, depression, or psychosis between Dr. Gaines’ surgery and his death. The court further stated that for Dr. Jarvis to be qualified as a professional, he needed to rely on facts and data commonly accepted within his field, ensuring their reliability:

Without a medical diagnosis for Kivland, the statements in Dr. Jarvis’ affidavit and deposition testimony become personal opinions rather than scientific conclusions. Admitting such opinions would be highly prejudicial to the defendants and improper under Missouri law.

Reassessing Dr. Jarvis’ Testimony

Applying the standards outlined in section 490.065, this Court finds that Dr. Jarvis’ professional opinion is admissible. As a board-certified psychiatrist with experience treating patients in similar situations, his testimony provides valuable insight into whether Kivland’s pain led to his suicide. If other evidence establishes Dr. Gaines’ negligence, Dr. Jarvis’ testimony will assist the trier of fact in determining whether that negligence directly resulted in Kivland’s death.

The circuit court suggested that the facts and data used by Dr. Jarvis were not commonly relied on within his field or lacked reasonable reliability. The ruling focused on the absence of a formal medical diagnosis and the lack of evidence proving Kivland’s insanity. However, under the clarified legal standard, the Kivlands do not need to prove that Gerald Kivland had an official psychiatric diagnosis or was clinically insane. Instead, they must provide evidence demonstrating that his suicide was a direct consequence of Dr. Gaines’ negligence.

Assessing the Validity of Dr. Jarvis’ Testimony

The circuit court suggested that Dr. Jarvis’ opinions lacked validity because he did not provide a medical diagnosis for Gerald Kivland. However, under the clarified standard, Dr. Jarvis was not required to diagnose Kivland with a specific medical condition to testify that his suicide directly resulted from Dr. Gaines’ negligence. Declaring Kivland “insane” would not add value to the analysis, as insanity is a legal term, not a medical diagnosis. See American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (4th ed. 2000).

Dr. Jarvis’ experience treating patients with conditions similar to Kivland’s qualifies him to form an informed opinion about the cause of Kivland’s suicide. A formal diagnosis might influence a jury’s perception of a professional’s testimony, but it is not a prerequisite for determining causation. Dr. Jarvis himself acknowledged that a jury might not believe him, demonstrating his understanding that juries evaluate factual disputes.

The Jury’s Role in Determining Causation

The central question—whether Kivland’s suicide directly resulted from his injury—should be left to a jury. The facts surrounding his death are not in dispute; rather, the issue lies in interpreting those facts. This type of decision is well-suited for a jury, much like determining “reasonable care,” which Justice Scalia has noted is a question for jurors when legal rules fail to provide a definitive answer.

Dr. Jarvis testified, with a reasonable degree of medical certainty, that:

1. Gerald Kivland took his life due to severe pain caused by his surgery.
2. His suicide was not a rational choice and, therefore, was not voluntary.

Evidence showed that Kivland’s paralysis and disability drastically altered his lifestyle. His pain was unbearable, and Dr. Jarvis testified that he reviewed these details—along with the case record—before forming his conclusions.

The Jury’s Role in Evaluating Testimony

Determining whether Dr. Jarvis’ testimony is credible falls within the jury’s responsibility, not the court’s. The circuit court’s disagreement with his conclusions does not justify excluding the testimony. Even if the court believes that the decedent voluntarily chose to end his life, this decision must be left to the jury. A court cannot dismiss testimony simply because it does not align with the judge’s perspective.

As established in Mitchell v. Kardesch, “Factual determinations of matters in dispute, including the weighing of medical opinions, rest solely within the province of the jury. It is error for the court to declare as a matter of law a result or legal effect which is within the exclusive province of the jury to determine.” 313 S.W.3d 667, 682-83 (Mo. banc 2010).

Conclusion

To succeed in their wrongful death claim, the Kivlands must prove that Gerald Kivland’s death was a direct result of Dr. Gaines’ medical negligence. Dr. Jarvis’ testimony supports their argument, allowing them to move forward with their case. His statements will help the jury decide whether the pain caused by Dr. Gaines’ actions led directly to Kivland’s suicide. However, negligence must still be proven with additional evidence.

Since causation remains a key issue of material fact, the jury must evaluate the case, making Dr. Jarvis’ testimony admissible. Therefore, the circuit court’s judgment on the wrongful death claim is reversed, while the ruling on the lost chance of survival is upheld. The case is remanded for further proceedings.

Contact Mutrux Firm Injury Lawyers

If you or a loved one has been affected by medical negligence, our team is here to help. Contact us today for a free case investigation and learn how we can fight for your rights.