Champagne v. U.S.

Decision Date08 March 1994
Docket NumberNo. 930215,930215
Citation513 N.W.2d 75
PartiesDebra CHAMPAGNE and Richard Champagne, as personal representatives of the Estate of Ricky Champagne, Plaintiffs and Appellants, v. UNITED STATES of America, Defendant and Appellee. Civ.
CourtNorth Dakota Supreme Court

Robert Vogel Law Office, P.C., Grand Forks, for plaintiffs and appellants; argued by Alice R. Senechal.

Sushma Soni (argued), Appellate Staff, Civ. Div., U.S. Dept. of Justice, Washington, DC and Cameron W. Hayden (appearance), Asst. U.S. Atty., U.S. Attorney's Office, Fargo, for defendant and appellee.

MESCHKE, Justice.

We consider the effect of comparative fault on a medical provider's tort liability for treating a patient with suicidal ideas when the patient commits suicide. Under NDRAppP 47 the United States Court of Appeals for the Eighth Circuit certified questions of law to this court:

(1) Is a suicide victim's fault to be considered under North Dakota's Comparative Fault Statutes, § 32-03.2-01 and 02; and

(2) Is any fault of the suicide victim attributable to the plaintiffs Debra Champagne and Richard Champagne who are the parents and surviving heirs of the suicide victim and institute this action as personal representatives of the estate of their deceased son.

Our answer to the first question is yes. A suicide victim's fault is considered under NDCC 32-03.2-02. But, if the medical provider, knowing the patient is suicidal and too mentally incapacitated to assume responsibility for his own well-being, undertakes a duty of care to the patient that takes in the patient's duty of self care, then the patient's fault in the act of suicide is greatly reduced. If the patient's act of suicide is a foreseeable result of the medical provider's breach of duty to treat the patient, the patient's act of suicide cannot be deemed a superseding cause of the patient's death that breaks the chain of causation between the medical provider and the patient, which absolves the medical provider of liability.

Our answer to the second question is that the fault of a suicide victim is attributable to plaintiffs who sue for wrongful-death damages.

For its statement of facts, the Circuit Court of Appeals used two memorandum opinions by the federal district court. We quote relevant parts:

The parents of Ricky Champagne, as the personal representatives of his estate, bring this medical malpractice/wrongful death action against the United States of America pursuant to the Federal Tort Claims Act, 28 U.S.C. §§ 2671 et seq., and 1346(b). The plaintiffs allege that employees of the Indian Health Services (IHS) in Belcourt, North Dakota, were negligent in their care of Ricky Champagne following his suicide attempt on January 25, 1989, and that this negligence was a proximate cause of his later suicide on February 20, 1989.

* * * * * *

On February 20, 1989, Ricky Champagne, an eighteen year-old Native American male, died as a result of a self-inflicted gunshot wound to the chest.

* * * * * *

The months prior to Ricky's death reflect the life of a troubled young man. Ricky turned eighteen two months prior to his death.

* * * * * *

On January 25, 1989, at approximately 1:00 p.m., Ricky attempted suicide with an overdose of medication, and was admitted to the IHS Hospital in Belcourt, North Dakota. Treatment to stabilize Ricky's medical condition was provided by Dr. James Blain. Dr. Blain referred Ricky to the IHS mental health unit for treatment of his mental condition, and wrote an order for someone to see Ricky immediately. Ricky was not seen by someone from the mental health unit until the following day.

Lance Azure, a social service representative in the mental health unit, met with Ricky on January 26 for one to two hours.... Based on the limited history that was obtained, it is surmised by the experts who testified in the case that Ricky was suffering from an adolescent adjustment disorder with suicidal ideations. However, some of the experts could not rule out major depression.... [T]he conflict between Ricky and his father weighed heavily on Ricky's mind.

On January 27, Dr. Blain wrote an order that Ricky could be discharged upon Mental Health's approval. Ricky was discharged on Azure's approval the next day on the condition that he return to see Azure later that afternoon. Ricky and his mother returned to the hospital that afternoon, but did not locate Azure.

IHS did not schedule or provide any further counseling for Ricky after his discharge. IHS did not refer Ricky for evaluation by, or consult with, a psychologist or psychiatrist.

Ricky returned home to live with his parents, but the tension between Ricky and his father remained unresolved. As is often the case, the subject of the suicide attempt was avoided. No counseling was provided the family in order to deal with the suicide attempt of a family member, or to resolve the conflicts in the family that may have led to the attempt.

On February 13, Debra went to see Azure and told him that her son had quit school again, had again moved away from home, and was giving away prized possessions, one of the classic signs of planned suicide. Azure responded to Debra's concerns by intimating that Ricky was eighteen, old enough to take care of himself and do what he wanted, and that Debra should not be concerned. However, Azure did attempt to contact Ricky, was unable to, and left a note at Ricky's grandmother's house. He made no further attempts to contact Ricky.

* * * * * *

Ricky called Azure on February 16, 1989, and Azure asked Ricky if he would like to make an appointment for counseling. Ricky made an appointment for the next day, but did not keep it. After the missed appointment, Azure took no subsequent action to contact Ricky or to determine whether Ricky was suicidal. At this point in time, Ricky had essentially received no counseling or other form of treatment since his discharge from the hospital. Ricky shot himself three days later.

* * * * * *

IHS recognizes its duty to give care to suicide attempters in its written suicide protocol, which states, "[e]very person giving evidence of suicidal ideation or suicidal behavior should be offered appropriate counseling and/or referral services."

* * * * * *

The testimony before the court establishes that the care given to Ricky was below accepted standards of care.

* * * * * *

All the experts agreed that, with appropriate intervention, it was more likely than not that Ricky's suicide would have been prevented.

* * * * * *

[T]he court concludes that the plaintiffs have established by a preponderance of the evidence that the negligence of IHS was a proximate cause of Ricky's death.

* * * * * *

The court concludes that Ricky's problems with his father were a contributing factor in his death.

However, after having considered the percentage of fault attributable to IHS, and the percentage of fault attributable to the father/son relationship, the court finds that this fault combined still does not approach 50% of the total fault that contributed to Ricky's death. Therefore, because the statutory framework at chapter 32-03.2 of the North Dakota Century Code contemplates that all fault including intentional acts must be considered, the court finds that Ricky bears the ultimate and primary responsibility for his own death.

* * * * * *

... Ricky's suicide note provides some evidence of his state of mind near the time of his death.... At the least, the note indicates that Ricky's death was a planned and intentional act. Thus, even though IHS failed to treat Ricky, in the final analysis it was Ricky who chose to take his own life and who must bear ultimate responsibility for his own death.

* * * * * *

Because the court finds that Ricky's intentional act of suicide is the primary proximate cause of his death, and because that conduct is attributable to his parents, recovery is barred.

See Champagne v. U.S., 836 F.Supp. 684 (D.C.N.D.1992), for further details.

This case asks us to decide how a patient's act of suicide should be compared with the fault of a medical provider who, knowing about the patient's propensity to commit suicide, fails to provide reasonable medical care. A medical provider treating a patient with suicidal ideas presents a uniquely complex situation for comparative fault. The Illinois Court of Appeals in Peoples Bank of Bloomington v. Damera, 220 Ill.App.3d 1031, 163 Ill.Dec. 475, 478, 581 N.E.2d 426, 429 (1991), cert. denied, 143 Ill.2d 648, 167 Ill.Dec. 409, 587 N.E.2d 1024 (1992), concluding that the patient-suicide victim's fault should not be compared, summarized the uniqueness of the situation:

[T]his case is different than the typical medical malpractice case because plaintiff here alleges medical malpractice by a psychiatrist treating a suicidal patient who ultimately committed suicide. The critical distinction between this case and all other medical malpractice cases is that here the patient does not share the goal of his physician of getting better; while the doctor is working to assist the patient to suppress suicidal tendencies, the patient, by the nature of his illness, may be working at cross-purposes to his doctor's suggestions and may not be interested in following instructions designed to enable him or her to safely take prescribed medication.

Because the act of suicide evidences that the course of treatment failed, there are difficulties in comparing the effects of a mental illness to reasonableness of the medical treatment.

In 1987, the Legislature enacted NDCC Ch. 32-03.2, and thereby shifted the focus for determining tort liability from traditional doctrinal categories to the singular, inclusive concept of "fault." See Erickson v. Schwan, 453 N.W.2d 765 (N.D.1990). In constructing this modified comparative fault system, the Legislature expressly combined a wide range of conduct, including willful conduct, for comparison in assessing liability for tort:

Contributory fault does not bar recovery in an action by...

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