Edwards v. Tardif

• Decision Date: 29 April 1997
• Docket Number: No. 15554,15554
• Citation: 240 Conn. 610,692 A.2d 1266
• Parties: Craig E. EDWARDS, Executor (Estate of Agatha M. Edwards) v. Daniel TARDIF et al.
• Court: Connecticut Supreme Court

Page 1266

692 A.2d 1266

240 Conn. 610

Craig E. EDWARDS, Executor (Estate of Agatha M. Edwards) v. Daniel TARDIF et al.

No. 15554.

Supreme Court of Connecticut.

Argued Jan. 14, 1997.

Decided April 29, 1997.

Andrew J. O'Keefe, with whom was Kathryn M. Cunningham, Hartford, for appellants (defendant Jeffrey Ettinger et al.).

Kathryn Calibey, with whom were David W. Cooney and Paul M. Iannaccone, Hartford, for appellee (plaintiff).

Before BORDEN, BERDON, NORCOTT, KATZ and McDONALD, JJ.

BERDON, Associate Justice.

The plaintiff, Craig E. Edwards, as executor of the estate of Agatha M. Edwards, brought this medical malpractice action for damages resulting from the suicide of Agatha M. Edwards (Edwards) against the defendant physicians Daniel Tardif (Tardif), Jeffrey Ettinger (Ettinger), and the defendant Tardif and Ettinger, P.C. (professional corporation). The jury rendered a verdict in favor of the plaintiff against Ettinger and the professional corporation in the amount of $504,750.07, ¹ and in favor of Tardif. Ettinger and the professional corporation subsequently moved to set aside the verdict and for judgment notwithstanding the verdict, both of which were denied by the trial court. ² Thereafter, Ettinger and the professional corporation ³ filed this appeal. ⁴ We affirm the judgment of the trial court.

The jury reasonably could have found the following facts. From 1981 to December, 1987, Edwards was treated by Tardif, an internist, for recurring clinical depression. Tardif's initial diagnosis in 1983 was mild depression, for which antidepressant medication was prescribed. In the years following the sudden death of Edwards' husband in 1985, her depression continued and intensified. In June, 1987, she was admitted to Manchester Memorial Hospital due to severe depression and alcohol abuse. While admitted in the hospital, Edwards expressed thoughts of suicide. The discharge diagnosis for Edwards revealed major affective disorder with depression and episodic alcohol abuse disorder.

During the June, 1987 admission, Tardif served as a consultant with respect to Edwards' illness and, subsequently, continued with her treatment. From the time of Edwards' discharge through December, 1987, Tardif's treatment included prescribing the antidepressant medication Tofranil. ⁵ On December 29, 1987, Tardif concluded that Edwards' depression had resolved and, therefore, discontinued the Tofranil medication. Tardif instructed Edwards to contact his office immediately upon the recurrence of depression. During the following ten months, however, there was no contact between Edwards and Tardif's office.

On October 5, 1988, Edwards telephoned Tardif's office complaining of depression. Ettinger, an internist who practiced with Tardif, was covering for Tardif on that date and returned Edwards' telephone call without first reviewing her medical chart. Ettinger had no prior knowledge of Edwards, had never treated her, and had never discussed her condition with Tardif. During the telephone conversation, Edwards informed Ettinger that she was depressed due to the approaching anniversary of her husband's death and because of difficulties at work. Ettinger did not inquire into the details of the events precipitating Edwards' depression, nor did he ascertain how many previous bouts of depression she had suffered. Rather than scheduling an appointment to evaluate Edwards, Ettinger determined as a result of the telephone conversation that she was depressed and prescribed 100 pills of Tofranil with two refills. Although Ettinger instructed her to contact Tardif in the next few weeks, no other follow-up measures were taken. Eight days later, on October 13, 1988, Edwards committed suicide by overdosing on the Tofranil pills prescribed by Ettinger. Edwards left behind a suicide note expressing her severe depression, torment and anguish.

At trial, the plaintiff presented the expert testimony of Douglas Berv, a psychiatrist and specialist in psychopharmacology. Berv stated that suicide is a known symptom and risk in individuals suffering from depression. He testified that Ettinger's treatment of Edwards fell below the accepted standard of care for internists in several respects. First, he testified that Ettinger prescribed a large amount of Tofranil over the telephone to a patient he had never seen without first having Edwards come in for a psychiatric evaluation and suicide assessment. He further testified that Ettinger had also made an assumption with respect to Edwards' condition and what her treatment should be when the ten month lapse in treatment required a full evaluation of her mental and physical status. Additionally, Berv testified that instead of arranging a psychiatric evaluation for Edwards within a few days after her telephone call, Ettinger suggested that she should call again to schedule an office visit. Berv opined that, had Ettinger conformed to the applicable standard of care, Edwards' death would have been prevented.

The defendants argue that, as a matter of law, the trial court should have set aside the verdict and rendered judgment in their favor because Edwards' suicide was unforeseeable and constituted an independent intervening cause. In response, the plaintiff asserts that there was sufficient evidence upon which the jury reasonably could find that Edwards' suicidal death was a foreseeable result of the defendants' failure to conform to the accepted standard of care for physicians in their line of practice. We agree with the plaintiff.

We begin with the premise that a physician is required by law to exercise the degree of skill, care and diligence that is customarily demonstrated by physicians in the same line of practice. Logan v. Greenwich Hospital Assn., 191 Conn. 282, 300-302, 465 A.2d 294 (1983). A physician must exercise such reasonable skill and diligence in all aspects of providing care and treatment to a patient. Allen v. Giuliano, 144 Conn. 573, 575, 135 A.2d 904 (1957). To prove that a physician has breached the legally required standard of care, a plaintiff must offer some evidence that the conduct of the physician was negligent. Snyder v. Pantaleo, 143 Conn. 290, 294, 122 A.2d 21 (1956). Except in the unusual case in which the want of care or skill is so gross that it presents an almost conclusive inference of want of care; Puro v. Henry, 188 Conn. 301, 305, 449 A.2d 176 (1982); the testimony of an expert witness is necessary to establish both the standard of proper professional skill or care on the part of a physician; Shelnitz v. Greenberg, 200 Conn. 58, 66, 509 A.2d 1023 (1986); "and that the defendant failed to conform to that standard of care." Mather v. Griffin Hospital, 207 Conn. 125, 131, 540 A.2d 666 (1988). Furthermore, the plaintiff must establish a causal relationship between the physician's negligent actions or failure to act and the resulting injury by showing that the action or omission constituted a substantial factor in producing the injury. Id., at 130, 540 A.2d 666.

Our inquiry in this case focuses on whether Edwards' suicide was an act that broke the chain of causation. "As a general rule, negligence actions seeking damages for the suicide of another will not lie because the act of suicide is considered a deliberate, intentional and intervening act which precludes a finding that a given defendant, in fact, is responsible for the harm." McLaughlin v. Sullivan, 123 N.H. 335, 337, 461 A.2d 123 (1983); see also annot., 11 A.L.R.2d 751, 756 (1950) ("[w]here an action is brought under a wrongful death statute the general rule is that suicide constitutes an intervening force which breaks the line of causation from the wrongful act to the death and therefore the wrongful act does not render [the] defendant civilly liable"). In other words, suicide generally is an unforeseeable result that serves to preclude civil liability. See, e.g., Tate v. Canonica, 180 Cal.App.2d 898, 913-14, 5 Cal.Rptr. 28 (1960); Eidson v. Reproductive Health Services, 863 S.W.2d 621, 627 (Mo.App.1993); McLaughlin v. Sullivan, supra, at 337-38, 461 A.2d 123. This common law rule has been stated as follows: "[I]f one is sane, or if the suicide is during a lucid interval, when one is in full command of all faculties, but life has become unendurable by reason of the injury, it is agreed in negligence cases that the voluntary choice of suicide is an abnormal thing, which supersedes the defendant's liability." W. Prosser & W. Keeton, Torts (5th Ed. 1984) § 44, p. 311.

Conversely, suicide will not break the chain of causation if it was a foreseeable result of the defendant's tortious act. In Wozniak v. Lipoff, 242 Kan. 583, 584, 750 P.2d 971 (1988), for example, the plaintiffs brought a medical malpractice action against a physician for negligence in the treatment of their decedent. The decedent had suffered from Graves' disease, a hormonal disorder, and depression. Id., at 584-85, 750 P.2d 971. During his treatment of the decedent, the defendant prescribed sixty pills of the antidepressant Sinequan with three refills, on which the decedent overdosed. Id., at 586-87, 750 P.2d 971. After a jury verdict for the plaintiffs, the defendant appealed, claiming that the decedent's death resulted from an intervening act other than his negligence. Id., at 599, 750 P.2d 971. The court recognized that the jury heard evidence that suicide is always a possibility in treating a depressed patient and that the appropriate standard of care in treating a depressed patient is to prescribe the lowest feasible amount of medication. Id. Accordingly, the court concluded, "there was competent evidence from which a rational factfinder could find [the defendant] should have reasonably foreseen the danger of [the decedent] committing suicide by an overdose of Sinequan." Id.

Several other courts have concluded that liability will be imposed on a physician when suicide was one of the foreseeable risks that made the physician's antecedent...